2016-05-16T15:07:17-05:00 2015-09-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2014-10-01 390829541 SHADY LANE INC SHAD 9206828254 1235 SOUTH 24TH STREET MANITOWOC WI 542205516 KASANDRA PAIDER CFO 9206828254 2016-05-12 1 TERRI REXRODE CPA MST P00096513 9206620016 2016-03-17 2014 2016-08-17 19:52:53Z KASANDRA PAIDER 1235 SOUTH 24TH STREET MANITOWOC WI 542205516 9557467 0 X WWW.SHADYLANEINC.COM X 1950 WI NURSING CARE FOR THE AGED AND DISABLED. 15 15 320 15 0 0 8838 8463 9964651 9465340 97040 43164 278301 12945 10348830 9529912 0 0 0 0 6416780 6675107 0 0 0 4116333 4097150 10533113 10772257 -184283 -1242345 19472099 13669745 5243929 886672 14228170 12783073 X SHADY LANE STRIVES TO PROVIDE OLDER ADULTS IN MANITOWOC COUNTY THE HIGHEST QUALITY RESIDENTIAL CARE AT A REASONABLE COST. RESIDENTS OF SHADY LANE CAN EXPECT TO ENJOY A HOME-LIKE SETTING WITH A SUPPORTIVE ATMOSPHERE THAT RESPECTS INDIVIDUALITY, PROMOTES PHYSICAL AND EMOTIONAL WELL BEING, AND ENCOURAGES INDEPENDENCE. 0 0 7420195 7156057 SKILLED NURSING SERVICES ARE OFFERED TO THE SENIOR POPULATION. THESE ARE THE HIGHER ACUITY POPULATION NEEDING THE MOST INTENSE SKILLED NURSING SERVICES. RESIDENTS TREATED CAN INCLUDE THE PRIVATE PAY RESIDENTS, AND THE RESIDENTS ON GOVERNMENT FUNDING (MEDICARE AND MEDICAID). NUMBER OF RESIDENTS TREATED IN PLAN YEAR WERE 280. 2149365 2072854 ASSISTED LIVING SERVICES ARE OFFERED TO THE LIGHTER CARE ASSISTED LIVING POPULATION. THESE RESIDENTS CAN MAINTAIN AN AMOUNT OF INDEPENDENCE WHILE STILL RECEIVING THE NECESSARY NURSING SERVICE TO MAINTAIN A QUALITY OF LIFE. RESIDENTS IN THE ASSISTED LIVING CAN INCLUDE THE PRIVATE PAY RESIDENTS AND RESIDENTS RECEIVING GOVERNMENT FUNDING. NUMBER OF RESIDENTS TREATED IN PLAN YEAR WERE 76. 9569560 1 0 0 0 0 0 0 0 1 1 1 0 0 1 0 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 0 0 0 1 9 0 320 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X KASANDRA PAIDER 9206828254 1235 S 24TH STREET MANITOWOC WI 54220 JIM NOFFKE BOARD CHAIR 0.50 X X 0 0 0 TOM MUELLER BOARD VICE CHAIR 0.50 X X 0 0 0 KATHERINE REYNOLDS BOARD SECRETARY 0.50 X X 0 0 0 DR JOSEPH DIRAIMONDO BOARD MEMBER 0.50 X 0 0 0 MARILYN KAUFMANN BOARD MEMBER 0.50 X 0 0 0 MIKE SCHAUS BOARD MEMBER 0.50 X 0 0 0 SCOTT MCMEANS BOARD MEMBER 0.50 X 0 0 0 JUDY CAREY BOARD MEMBER 0.50 X 0 0 0 DENNIS TIENOR BOARD MEMBER 0.50 X 0 0 0 DON KARMAN BOARD MEMBER 0.50 X 0 0 0 RONALD HINZ BOARD MEMBER 0.50 X 0 0 0 SANDY HARDRATH BOARD MEMBER 0.50 X 0 0 0 STANLEY JOHNSON BOARD MEMBER 0.50 X 0 0 0 RHONDA TRADER BOARD MEMBER 0.50 X 0 0 0 JEREMY SEHLOFF BOARD MEMBER 0.50 X 0 0 0 TODD MEERDINK CEO 40.00 X 150450 0 30749 KASANDRA PAIDER CFO 40.00 X 49260 0 10070 199710 0 40819 1 0 1 0 HOLY FAMILY REHAB SERVICE 2100 WESTERN AVE MANITOWOC WI 54220 THERAPY SERVICES 485424 OMNICARE PO BOX 78000 DETROIT MI 48278 PHARMACY SERVICES 193572 WEATHER-TITE EXTERIORS 1533 7TH STREET GREEN BAY WI 54304 BUILDING SERVICES 185642 3 8463 8463 SKILLED NURSING FACILI 623000 7156057 7156057 ASSISTED LIVING FACILI 623000 2072854 2072854 CAFETERIA REVENUES 623000 195779 195779 OTHER 623000 26617 26617 BEAUTY & BARBER SHOP 623000 14033 14033 9465340 43164 43164 40500 27555 12945 12945 12945 9529912 9228911 0 292538 240529 240529 5224408 4875186 349222 78300 69847 8453 727573 649120 78453 404297 360653 43644 11179 11179 26350 26350 611695 539355 72340 126185 126185 1581491 1444903 136588 303570 285366 18204 2272 1869 403 3588 3588 802139 754037 48102 213248 194819 18429 BED ASSESSMENT 241400 241400 BAD DEBT EXPENSE 70000 70000 REPAIRS AND MAINTENANCE 47578 47578 56455 31839 24616 10772257 9569560 1202697 0 363616 207660 62813 66973 795828 647138 34770 31270 112249 83581 15884601 8784833 7040374 7099768 10955192 4592970 107257 940385 19472099 13669745 823732 868932 20197 17740 4400000 5243929 886672 X 14203170 12758073 25000 25000 14228170 12783073 19472099 13669745 X -1242345 -125397 -77355 X X 0 1 X 1 0 X 746 10702 8838 8463 28749 11538152 10550512 10229343 10010778 9228911 51557696 212907 243988 299415 217255 236429 1209994 11751059 10795246 10539460 10236871 9473803 52796439 0 16434 16434 16434 16434 52780005 169995 143056 128891 137540 83664 663146 169995 143056 128891 137540 83664 663146 11921054 10938302 10668351 10374411 9557467 53459585 0.98730 0.98570 0.01240 0.01430 X 0 1 X 25000 18 18 25000 25000 15 15 25000 25000 50 50 25000 25000 73 73 25000 25000 50 50 25000 1.00000 0 0 216216 216216 12430003 7446180 4983823 3238382 1338653 1899729 7099768 INVESTMENT IN LAKESHORE COMMUNITY FOUNDATION 922645 RESIDENT FUNDS HELD IN TRUST 17740 940385 9350413 -125397 -77355 -202752 9553165 -23253 -23253 9529912 10795510 27555 27555 10767955 4302 4302 10772257 PART IV, LINE 2B: RESIDENTS' FUNDS HELD IN TRUST CONSIST OF AMOUNTS ON DEPOSIT WITH THE ORGANIZATION BY RESIDENTS FOR SAFEKEEPING. THESE FUNDS CAN BE WITHDRAWN AT ANY TIME BY THE RESIDENTS. PART V, LINE 4: PERMANENTLY RESTRICTED NET ASSETS AT SEPTEMBER 30, 2015 REPRESENT A DONOR-RESTRICTED ENDOWMENT FUND. THE INCOME FROM THE ENDOWMENT FUND IS EXPENDABLE TO SUPPORT INCIDENTAL EXPENSES OF RESIDENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN LAKESHORE COMMUNITY FOUNDATION -77,355. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS 4,302. RENTAL EXPENSES -27,555. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 27,555. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS 4,302. X X X 0 0 0 0 0 0 0 0 0 TODD MEERDINK CEO 145450 0 5000 0 0 0 4858 0 25891 0 181199 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ORGANIZATIONS' BOARD OF DIRECTORS EXECUTIVE COMMITTEE BEFORE IT WAS FILED AND IS AVAILABLE TO ALL BOARD MEMBERS UPON REQUEST. THE EXECUTIVE COMMITTEE DESIGNATES THE DETAIL REVIEW OF THE FORM 990 TO MANAGEMENT, BUT HAS FINAL APPROVAL OF THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS AUTHORIZES THE OFFICERS OF THE ORGANIZATION TO PERIODICALLY, BUT NOT LESS THAN ANNUALLY, SURVEY THE BOARD MEMBERS REGARDING ANY POTENTIAL CONFLICTS, TO MAINTAIN SUCH INFORMATION AND REPORT BACK TO THE BOARD REGARDING ANY POTENTIAL CONFLICTS OF INTEREST. BOARD MEMBERS HAVE THE DUTY TO FULLY DISCLOSE TO THE BOARD, PRIOR TO DELIBERATIONS, THE NATURE AND EXTENT OF ANY INTEREST IN ANY TRANSACTION BEING CONSIDERED. AFTER THE DISCLOSURE IS MADE AND THE INTERESTED PARTY ANSWERS ALL APPROPRIATE QUESTIONS, HE SHALL DEPART FROM THE PORTION OF THE MEETING IN WHICH THE TRANSACTION IS BEING CONSIDERED AND SHALL NOT PARTICIPATE IN FURTHER DISCUSSION OF OR VOTE ON THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION FOR THE OFFICERS AND OTHER KEY EMPLOYEES OF THE ORGANIZATION INCLUDE: 1) REVIEW AND APPROVAL BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS (THOSE WITHOUT CONFLICT); 2) USE OF DATA AS TO COMPARABLE COMPENSATION; AND 3) CONTEMPORANEOUS DOCUMENTATION AND RECORD KEEPING. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION BELIEVES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE THE PROPERTY OF THE ORGANIZATION AND DOES NOT MAKE THEM AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN LAKESHORE COMMUNITY FOUNDATION -77,355. FORM 990, PART XII, LINE 2C: FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF THE AUDIT FIRM. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.