2016-05-16T15:57:20-05:00 2015-12-31 810385940 ANDERSON ZURMUEHLEN & CO PC PO BOX 748 BUTTE MT 59703 990 2015-01-01 364016275 WISCONSIN ILLINOIS SENIOR HOUSING INC WISC 2627288167 13185 W GREEN MOUNTAIN DRIVE LAKEWOOD CO 80228 ANDY KERWIN SECRETARY 2627288167 2016-05-16 1 JAMES E WOY P00102054 4067820451 2016-05-16 2015 2016-12-15 16:53:06Z ANDY KERWIN 13185 W GREEN MOUNTAIN DRIVE LAKEWOOD CO 80228 48854333 0 X WWW.WISCONSINILLINOISSENOIRHOUSING.ORG X 1994 IL SKILLED NURSING AND ASSISTED LIVING FACILITIES. 7 7 1619 0 0 0 32354 2858251 41723958 45725904 205805 84981 9333 -11059 41971450 48658077 0 0 0 0 24574553 28100033 0 0 0 17827789 19394576 42402342 47494609 -430892 1163468 67919000 69125291 62553100 62664425 5365900 6460866 THE PRIMARY PURPOSE IS TO PROVIDE SKILLED NURSING AND ASSISTED LIVING FACILITIES FOR AGED INDIVIDUALS. 0 0 35525096 40184364 WISCONSIN ILLINOIS SENIOR HOUSING, INC.(WISH) OWNS AND OPERATES SKILLED NURSING AND ASSISTED LIVING FACILITIES. THE ORGANIZATION CONSISTS OF: EAST TROY MANOR--50 BED FACILITY, EDGERTON CARE CENTER--61 BED FACILITY, FAIR OAKS HEALTH CENTER--51 BED FACILITY, GENEVA LAKE MANOR--60 BED FACILITY, WILD ROSE MANOR--50 BED FACILITY, HOLTON MANOR--60 BED FACILITY, INGLESIDE MANOR--100 BED SKILLED NURSING AND 22 BED COMMUNITY BASED RESIDENTIAL FACILITY, MONTELLO CARE CENTER--50 BED SKILLED NURSING AND 14 BED COMMUNITY BASED RESIDENTIAL FACILITY, AND MAPLE RIDGE CARE CENTER--75 BED SKILLED NURSING FACILITY. 4654370 5541609 WELLINGTON HOMES OF WISCONSIN WAS ORGANIZED TO OPERATE SIX RESIDENTIAL ASSISTED LIVING FACILITIES OF THE BENEFIT OF THE ELDERLY. THE FACILITES HAVE A COMBINED TOTAL OF 160 BEDS. ALL HOMES ARE LOCATED IN THE FOLLOWING WISCONSIN LOCATIONS: FORT ATKINSON, HARTFORD, STEVENS POINT, WAUSAU, AND WISCONSIN RAPIDS. WELLINGTON HOMES OF WISCONSIN, LLC IS A LIMITED LIABILITY CORPORATION OPERATING AS A DISREGARDED ENTITY. THE FEDERAL ID NUMBER IS 26-0564338. THE SOLE MEMBER OF THE LLC IS WISCONSIN ILLINOIS SENIOR HOUSING, INC. THE ASSISTED LIVING FACILITY OPERATIONS BEGAN IN SEPTEMBER 2007. 40179466 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 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 1 0 0 0 0 1 115 0 1 1619 1 0 0 0 0 0 1 1 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X CINDY DEMOYE 3039800611 13185 W GREEN MOUNTAIN DRIVE LAKEWOOD CO 80228 X CHARLES W NASON CHAIRMAN 1.00 X X 0 0 0 KEN DEVITO MEMBER 1.00 X 0 0 0 LORRIE DUPONT MEMBER 1.00 X 0 0 0 ANDREW KERWIN SECRETARY 1.00 X X 0 0 0 MIRIAM GEHLER TREASURER (PART-YEAR) 1.00 X X 0 0 0 NICHOLAS LYNN MEMBER 1.00 X 0 0 0 RAJEEV KUMAR MEMBER 1.00 X 0 0 0 JILL KRUEGER TREASURER (PART-YEAR) 1.00 X X 0 0 0 KAREN CARRIG MEMBER 1.00 X 0 0 0 JOYCE SURDICK ADMINISTRATOR 40.00 X 109729 0 0 DONNA KRUTCHEN ADMINISTRATOR 40.00 X 105592 0 0 HEATHER BARTELL ADMINISTRATOR 40.00 X 101065 0 0 316386 0 0 3 0 0 0 CARRIAGE HEALTHCARE INC 13185 W GREEN MTN DRIVE LAKEWOOD CO 80228 MANAGEMENT COMPANY 1823136 OMNICARE PO BOX 78000 DETROIT MI 482781668 PHARMACY 779718 MARTIN BROTHERS PO BOX 69 CEDAR FALLS IA 50613 FOOD SERVICES 567794 REINHART FOODS 2655 EAST RICHMOND STREET SHAWANO WI 51466 FOOD SERVICES 500490 GENESIS REHAB SERVICES PO BOX 821322 PHILADELPHIA PA 191821322 THERAPY SERVICES 398963 12 2858251 2858251 RESIDENT CARE REVENUE 623000 29238655 29238655 ANCILLIARY REVENUE 623000 9346851 9346851 ASSISTED LIVING REVENUE 623000 6665623 6665623 MISC PATIENT BENEFIT REVENUE 623000 474775 474775 45725904 83875 83875 10505 21633 -11128 -11128 -11128 175729 174623 1106 1106 1106 MISC. REVENUE 623000 69 69 69 48658077 45725973 0 73853 24690036 24347290 342746 1154030 1069333 84697 2255967 2109558 146409 1860716 1860716 144156 144156 250765 250765 30834 30834 88060 10157 77903 190200 55454 134746 1728401 1597978 130423 137177 20268 116909 2958989 64214 2894775 2010840 2010840 379470 379164 306 SUPPLIES 4136491 4134947 1544 PURCHASED SERVICES AND 2206526 1838996 367530 BUSINESS TAXES 1060448 1060448 BAD DEBT EXPENSE 789243 789243 1422260 680551 741709 47494609 40179466 7315143 0 7516 11374 3918084 3804990 4473300 4164780 74771 30 140917 251628 63278145 14744173 43889600 48533972 1967100 1968376 10965900 8200056 2481812 2190085 67919000 69125291 6510900 7924866 55990400 54625010 17160 51800 97389 62553100 62664425 X 5365900 6460866 5365900 6460866 67919000 69125291 X 1163468 -67261 -1241 X X 0 1 X 1 0 X 21937 57422 35682 43456 2858251 3016748 31588458 33464363 41187684 41723958 45724959 193689422 31610395 33521785 41223366 41767414 48583210 196706170 0 0 0 196706170 139265 534803 112430 132848 94375 1013721 139265 534803 112430 132848 94375 1013721 31749660 34056588 41335796 41900262 48677585 197719891 0.99490 0.99380 0.00510 0.00620 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3287774 3287774 59990371 14744173 45246198 48533972 RESTRICTED BOND RESERVES 8200056 F 8200056 RESIDENT TRUST ACCOUNTS 97389 97389 X 47795900 -67300 -816221 -883521 48679421 -21344 -21344 48658077 46699900 21512 21512 46678388 816221 816221 47494609 PART X, LINE 2: FOOTNOTE 1 TO THE FINANCIAL STATEMENTS STATES MANAGEMENT HAS REVIEWED ITS OPERATIONS FOR UNCERTAIN TAX POSITIONS AND HAS DETERMINED NO UNCERTAIN TAX POSITIONS EXIST. PART XI, LINE 2D ADJUSTMENT (1) -$789,300 - PROVISION FOR BAD DEBT IS PRESENTED IN PATIENT REVENUES FOR FINANCIAL REPORTING PRESENTATION. ADJUSTMENT (2) -$26,921 - FINANCIAL STATEMENTS INCLUDED THIS MUCH OF ANCILLARY EXPENSES REVENUES. PART XI, LINE 4B ADJUSTMENT (1) -$21,633 - RENTAL EXPENSE IS REPORTED IN REVENUES ON THE FORM 990. ADJUSTMENT (2) $289 ROUNDING DIFFERENCE. PART XII, LINE 2D ADJUSTMENT (1) -$121 - ROUNDING TO THE AUDITED FINANCIAL STATEMENTS. ADJUSTMENT (2) $21,633 - RENTAL EXPENSE IS REPORTED IN REVENUE ON THE FORM 990. PART XII, LINE 4B ADJUSTMENT (1) $789,300 - THE PROVISION FOR BAD DEBT IS INCLUDED IN EXPENSES ON THE FORM 990. A WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710V4B1 2007-09-07 585000 ACQUISITION OF SIX ASSISTED LIVING FACILITIES LOCATED IN WISCONSIN 0 0 0 B WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710V460 2007-09-17 1130000 ACQUISITION OF SIX ASSISTED LIVING FACILITIES LOCATED IN WISCONSIN 0 0 0 C WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710V4H8 2007-09-17 3605000 ACQUISITION OF SIX ASSISTED LIVING FACILITIES LOCATED IN WISCONSIN 0 0 0 D WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 9771044J4 2007-09-17 7935000 ACQUISITION OF SIX ASSISTED LIVING FACILITIES LOCATED IN WISCONSIN 0 0 0 A 2007 0 0 0 0 B 2007 0 0 0 0 C 2007 0 0 0 0 D 2007 0 0 0 0 A 0 0 0 0 0 1 0 0 B 0 0 0 0 0 1 0 0 C 0 0 0 0 0 1 0 0 D 0 0 0 0 0 1 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 A WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 977108VD1 2010-08-01 980000 REFINANCE AND IMPROVEMENTS OF LIVING FACILITIES 0 0 0 B WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710BVE9 2010-08-01 1275000 REFINANCE AND IMPROVEMENTS OF LIVING FACILITIES 0 0 0 C WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 977108BG4 2010-08-01 6910000 REFINANCE AND IMPROVEMENTS OF LIVING FACILITIES 0 0 0 D WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710B2H4 2012-08-07 2070000 ACQUISITION OF 1 FACILITY LOCATED IN WISCONSIN AND IMPROVEMENTS OF LIVING FA 0 0 0 A 2010 0 0 0 0 B 2010 0 0 0 0 C 2010 0 0 0 0 D 2012 0 0 0 0 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 A WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710B2J0 2012-08-07 3440000 ACQUISITION OF 1 FACILITY LOCATED IN WISCONSIN AND IMPROVEMENTS OF LIVING FA 0 0 0 B WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710B2K7 2012-08-07 6070000 ACQUISITION OF 1 FACILITY LOCATED IN WISCONSIN AND IMPROVEMENTS OF LIVING FA 0 0 0 C WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710BZ96 2012-08-07 225000 ACQUISITION OF 1 FACILITY LOCATED IN WISCONSIN AND IMPROVEMENTS OF LIVING FA 0 0 0 D WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710B2A9 2012-08-07 230000 ACQUISITION OF 1 FACILITY LOCATED IN WISCONSIN AND IMPROVEMENTS OF LIVING FA 0 0 0 A 2012 0 0 0 0 B 2012 0 0 0 0 C 2012 0 0 0 0 D 2012 0 0 0 0 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 A WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710B2B7 2012-08-07 235000 ACQUISITION OF 1 FACILITY LOCATED IN WISCONSIN AND IMPROVEMENTS OF LIVING FA 0 0 0 B WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710B2C5 2012-08-07 245000 ACQUISITION OF 1 FACILITY LOCATED IN WISCONSIN AND IMPROVEMENTS OF LIVING FA 0 0 0 C WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710B2D3 2012-08-07 255000 ACQUISITION OF 1 FACILITY LOCATED IN WISCONSIN AND IMPROVEMENTS OF LIVING FA 0 0 0 D WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710B2E1 2012-08-07 265000 ACQUISITION OF 1 FACILITY LOCATED IN WISCONSIN AND IMPROVEMENTS OF LIVING FA 0 0 0 A 2012 0 0 0 0 B 2012 0 0 0 0 C 2012 0 0 0 0 D 2012 0 0 0 0 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 A WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710B2F8 2012-08-07 275000 ACQUISITION OF 1 FACILITY LOCATED IN WISCONSIN AND IMPROVEMENTS OF LIVING FA 0 0 0 B WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710B2G6 2012-08-07 290000 ACQUISITION OF 1 FACILITY LOCATED IN WISCONSIN AND IMPROVEMENTS OF LIVING FA 0 0 0 C WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DDD5 2013-11-06 430000 IMPROVEMENTS OF 1 FACILITY LOCATED IN WISCONSIN. 0 0 0 D WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DDJ2 2013-11-06 7525000 IMPROVEMENTS OF 1 FACILITY LOCATED IN WISCONSIN. 0 0 0 A 2012 0 0 0 0 B 2012 0 0 0 0 C 2014 0 0 0 0 D 2014 0 0 0 0 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 A WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 2014-12-01 10330000 REFINANCE DEBT PREVIOUSLY FINANCED FOR ACQUISITION OF FIVE NURSING HOMES 0 0 0 B WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 2014-12-01 3450000 IMPROVEMENTS OF 1 FACILITY LOCATED IN WISCONSIN. 0 0 0 A 2014 1 0 0 0 B 0 0 0 0 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS ENGAGED CARRIAGE HEALTHCARE INC. (CHC) TO PROVIDE MANAGEMENT SERVICES THROUGH JUNE 30, 2018. CHC IS AN INDEPENDENT "FOR PROFIT ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD HAS DESIGNATED THE CHAIRMAN AND SECRETARY TO REVIEW AND SIGN THE 990 ON BEHALF OF THE BOARD. ALL BOARD MEMBERS RECEIVE A COPY OF FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY IS MONITORED THROUGH THE CORPORATE COMPLIANCE PROGRAM. REPORTS ARE PROVIDED TO THE BOARD ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION AND MANAGEMENT COMPANY AGREEMENTS ARE REVIEW BY INDEPENDENT BOARD MEMBERS ON AN ANNUAL BASIS. COMPARABLE DATA IS OBTAINED IN ORDER TO ESTABLISH REASONABLE AMOUNTS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL PROVIDE DOCUMENTS UPON WRITTEN REQUEST TO THE COMPANY. FORM 990, PART XI, LINE 9: ROUNDING -1,241. FORM 990 - LINE 2C SCHEDULE XI THE ENTIRE BOARD REVIEWS AND HAS RESPONSIBILITY FOR THE FINANCIAL STATEMENTS. THIS POLICY IS UNCHANGED FROM PRIOR YEARS. WELLINGTON HOMES OF WISCONSIN LLC 13185 WEST GREEN MOUNTAIN DRIVE LAKEWOOD CO 80228 260564338 ASSISTED LIVING FACILITY WI N/A