2015-03-02T16:17:22-06:00 2014-09-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2013-10-01 390829541 SHADY LANE INC SHAD 9206828254 1235 SOUTH 24TH STREET MANITOWOC WI 542205516 KASANDRA PAIDER TREASURER 9206828254 2015-02-18 1 TERRI REXRODE CPA MST P00096513 9206620016 2015-02-18 2013 2016-03-07 17:11:31Z KASANDRA PAIDER 1235 SOUTH 24TH STREET MANITOWOC WI 542205516 10374411 0 X WWW.SHADYLANEINC.COM X 1950 WI NURSING CARE FOR THE AGED AND DISABLED. 14 14 309 15 0 0 10702 8838 10530450 9964651 128926 97040 57213 278301 10727291 10348830 0 0 0 0 6467709 6416780 0 0 0 3898318 4116333 10366027 10533113 361264 -184283 20059503 19472099 5654299 5243929 14405204 14228170 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 7730585 8224456 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 334. 1679055 1786322 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 96. 9409640 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 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 8 0 309 1 0 0 0 0 0 0 0 0 0 0 X 14 14 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 DR SEAN BENHAM BOARD MEMBER 0.50 X 0 0 0 JUDY CAREY BOARD MEMBER 0.50 X 0 0 0 DENNIS TIENER BOARD MEMBER 0.50 X 0 0 0 DON KARMAN BOARD MEMBER 0.50 X 0 0 0 RON 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 RON SCHWALBE FORMER BOARD MEMBER 0.50 X 0 0 0 MELANIE TIEDT FORMER BOARD MEMBER 0.50 X 0 0 0 DEB GABRIEL FORMER BOARD MEMBER 0.50 X 0 0 0 ALEX OLSON FORMER BOARD MEMBER 0.50 X 0 0 0 ROXANNA STRAWN FORMER BOARD MEMBER 0.50 X 0 0 0 TODD MEERDINK CEO - ADMINISTRATOR 40.00 X 149500 0 32148 KASANDRA PAIDER CFO/BOARD TREASURER 40.00 X 36427 0 8666 GREGG CHALOUPKA FORMER CFO/BOARD TREASURER 40.00 X 65824 0 10063 251751 0 50877 1 0 1 0 HOLY FAMILY REHAB SERVICE 2100 WESTERN AVE MANITOWOC WI 54220 THERAPY SERVICES 454928 OMNICARE PO BOX 78000 DETROIT MI 48278 PHARMACY SERVICES 158043 2 8838 8838 SKILLED NURSING FACILITY 623000 8008072 8008072 ASSISTED LIVING FACILITY 623000 1739324 1739324 CAFETERIA REVENUES 623000 172196 172196 OTHER 623000 30434 30434 BEAUTY & BARBER SHOP 623000 14625 14625 9964651 97040 97040 40500 25581 14919 14919 14919 STORM DAMAGE PROCEEDS 900099 263382 263382 263382 10348830 10010778 0 329214 302627 302627 5260753 4906376 354377 68174 59786 8388 328602 287769 40833 456624 406416 50208 1501 1501 27289 27289 607959 569647 38312 100206 100206 1536931 1449601 87330 356258 334894 21364 2810 2410 400 79435 74671 4764 719319 676183 43136 218375 199108 19267 BED ASSESSMENT 265200 265200 BAD DEBT EXPENSE 102864 102864 REPAIRS AND MAINTENANCE 37481 37481 60705 37234 23471 10533113 9409640 1123473 0 738257 363616 77592 96017 811610 795828 40570 34770 112656 112249 15376366 8335992 7324948 7040374 10864927 10955192 88943 74053 20059503 19472099 854299 843929 4800000 4400000 5654299 5243929 X 14380204 14203170 25000 25000 14405204 14228170 20059503 19472099 -184283 7249 0 X X 0 1 X 1 0 X 1496 746 10702 8838 21782 11378683 11538152 10550512 10229343 10010778 53707468 187111 212907 243988 299415 217255 1160676 11567290 11751059 10795246 10539460 10236871 54889926 0 4594 4594 4594 4594 54885332 218564 169995 143056 128891 137540 798046 218564 169995 143056 128891 137540 798046 11785854 11921054 10938302 10668351 10374411 55687972 0.98560 0.98330 0.01430 0.01670 X 25000 15 15 25000 25000 50 50 25000 25000 73 73 25000 25000 50 50 25000 25000 287 287 25000 1.00000 0 0 216216 216216 12340574 6997351 5343223 2747433 1338641 1408792 72143 72143 7040374 X 10372472 7249 7249 10365223 -16393 -16393 10348830 10549506 25581 25581 10523925 9188 9188 10533113 PART V, LINE 4: PERMANENTLY RESTRICTED NET ASSETS AT SEPTEMBER 30, 2014 REPRESENT A DONOR-RESTRICTED ENDOWMENT FUND. THE INCOME FROM THE ENDOWMENT FUND IS EXPENDABLE TO SUPPORT INCIDENTAL EXPENSES OF RESIDENTS. PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE ORGANIZATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE ORGANIZATION HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF SEPTEMBER 30, 2014 OR 2013. THE ORGANIZATION'S FEDERAL RETURNS FOR TAX YEARS 2011 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS 9,188. RENTAL EXPENSES -25,581. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 25,581. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS 9,188. X X X 0 0 0 0 0 0 0 0 0 TODD MEERDINK CEO - ADMINISTRATOR 142000 0 7500 0 0 0 4933 0 27215 0 181648 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 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.