2014-01-29T05:38:32-06:00 2013-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2012-07-01 391020547 CLEMENT MANOR INC CLEM 4143211800 3939 S 92ND ST GREENFIELD WI 53228 DENNIS FERGER 4143211800 2014-01-21 1 TERRI REXRODE CPA MST P00096513 9206620016 2014-01-21 2012 2015-11-30 17:44:51Z DENNIS FERGER 3939 S 92ND ST GREENFIELD WI 53228 21965683 0 0928 X WWW.CLEMENTMANOR.COM X 1963 WI CLEMENT MANOR IS A NON-PROFIT ORGANIZATION SPONSORED BY THE SCHOOL SISTERS OF ST. FRANCIS AND IS DEEPLY ROOTED IN THE FRANCISCAN VALUE SYSTEM. CLEMENT MANOR'S RETIREMENT COMMUNITY OFFERS A FULL CONTINUUM OF SERVICES TO PROMOTE THE HEALTHY AGING OF CLIENTS IN THEIR FACILITIES AND THE COMMUNITY. SINCE 1982, CLEMENT MANOR HAS STOOD BY THE VALUES OF RESPECT, COLLABORATION, AND QUALITY SERVICE, MAINTAINING A TRADITION OF SERVICE EXCELLENCE AND THE PURSUIT OF QUALITY. CLEMENT MANOR'S STAFF AND ADMINISTRATION ARE DEDICATED TO THE CLIENTS THEY SERVE, ALWAYS KEEPING THE FACILITY AT THE FOREFRONT OF IMPROVEMENTS IN THE LONG TERM CARE INDUSTRY TO ENSURE THE BEST CARE POSSIBLE. CLEMENT MANOR IS ALSO AN ASSOCIATE MEMBER OF THE BENEDICTINE HEALTH SYSTEM, A CATHOLIC HEALTH CARE ORGANIZATION WELL-KNOWN AND RESPECTED IN THE PROFESSION. 12 12 443 119 0 0 134694 148670 21525774 21703580 28852 22334 21809 27331 21711129 21901915 0 0 0 0 13079735 12890097 0 0 47836 8407704 9022996 21487439 21913093 223690 -11178 19781076 20604955 20789614 21490013 -1008538 -885058 X CLEMENT MANOR IS A HEALTHCARE ORGANIZATION SPONSORED BY THE SCHOOL SISTERS OF ST. FRANCIS THAT IS COMMITTED TO PROVIDING A CONTINUUM OF CARE AND FOSTERING THE HIGHEST POTENTIAL FOR WELL BEING OF EACH INDIVIDUAL ON OUR CAMPUSES AND IN OUR COMMUNITIES THROUGH THE VALUES OF RESPECT, COLLABORATION AND QUALITY SERVICE. 0 0 18616982 21311355 CLEMENT MANOR, INC. OPERATES A SKILLED NURSING FACILITY, A CONTINUING CARE FACILITY WHICH INCLUDES A RESIDENTIAL CARE APARTMENT COMPLEX, AND AN ADULT AND CHILD CARE CENTER. AS PART OF ITS CATHOLIC HERITAGE, CLEMENT MANOR IS DEDICATED TO PROVIDING BOTH SERVICES AND LEADERSHIP IN THE COMMUNITY FOR CARE OF THE POOR.ALSO, CLEMENT MANOR, INC. PROVIDES CARE TO THE INDIGENT UNDER THE MEDICAID PROGRAM. THE COST NECESSARY TO PROVIDE CARE TO THESE RESIDENTS GENERALLY EXCEEDS MEDICAID REIMBURSEMENT. UNREIMBURSED CHARGES FOR THE MEDICAID RESIDENTS IN FISCAL 2013 WAS APPROXIMATELY $3,295,000IN ADDITION CLEMENT PROVIDED APPROXIMATELY $42,000 OF CHARITY CARE SERVICES TO THE NEEDY IN FISCAL 2013. 18616982 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 81 0 1 443 1 0 0 0 0 0 1 1 0 0 0 0 X 12 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X DIANE LEPKOWSKI 4143211800 3939 SOUTH 92ND STREET GREENFIELD WI 53228 WILLIAM BAZAN 0.30 X 0 0 0 THOMAS R ALLEN 0.30 X 0 0 0 SISTER HELEN BUTZLER 0.30 X 0 0 0 PATRICE BARTELME 0.30 X 0 0 0 SISTER MARY YANNY 0.30 X 0 0 0 JODIE LANE 0.30 X 0 0 0 SISTER CAROL GRANDLICH 0.30 X 0 0 0 STEPHEN SKORONSKI 0.30 X X 0 0 0 THOMAS M GAZZANA 0.30 X X 0 0 0 KRISTY A NIELSON PHD 0.30 X X 0 0 0 SISTER JUDEEN SCHULTE 0.30 X X 0 0 0 KEVIN NITKA 0.30 X X 0 0 0 RICHARD RAU 40.00 X 240095 0 24087 DENNIS FERGER 40.00 X 177951 0 24631 LINDA STRUHAR 40.00 X 117804 0 16652 535850 0 65370 3 0 1 0 REHABCARE GROUP 7733 FORSYTH BLVD ST LOUIS MO 63105 THERAPY SERVICES 1520525 ROESCHEN INTERMED PHARMACY 3433 DOUGLAS AVE RACINE WI 53402 PHARMACY SERVICES 425566 2 56884 91786 148670 RESIDENT SERVICE REVENUE 623000 19781990 19781990 RESIDENT ADMINISTRATIVE SERVICE R 623000 995660 995660 DAYCARE REVENUE 623000 422736 422736 MISCELLANEOUS RESIDENT SERVICES 623000 188005 188005 BEAUTY/BARBER SHOP REVENUE 623000 112522 112522 202667 110969 91698 21703580 22334 22334 20824 0 20824 20824 20824 42836 56884 42836 0 27439 20932 6507 6507 21901915 21311355 0 441890 X 466764 466764 9875201 8878738 956614 39849 319992 274718 45274 1489773 1278993 210780 738367 633900 101419 3048 7310 7310 36064 36064 2378166 2041693 336473 2227268 1826488 399735 1045 1518530 1518530 31370 26932 4438 39957 34304 5653 1367004 1367004 174900 174900 MISCELLANEOUS 700769 597682 99193 3894 LOSS ON DEBT REFINANCIN 403658 403658 BAD DEBT EXPENSE 138000 138000 21913093 18616982 3248275 47836 1723192 2226861 1671279 1428966 80261 76149 88584 137299 31634134 18868848 13295167 12765286 2518100 3623869 404493 346525 19781076 20604955 2378058 1995471 13900937 15367000 4510619 4127542 20789614 21490013 X -1008538 -885058 -1008538 -885058 19781076 20604955 X -11178 3839 130820 X X 0 1 X 1 0 X 313577 167007 105840 134694 148670 869788 18665627 19635797 20101098 21088776 21311355 100802653 504040 480416 486908 499761 462500 2433625 19483244 20283220 20693846 21723231 21922525 104106066 5001 5000 5000 5000 5000 25001 0 5001 5000 5000 5000 5000 25001 104081065 181252 117811 71846 44181 43158 458248 181252 117811 71846 44181 43158 458248 19664496 20401031 20765692 21767412 21965683 104564314 0.99540 0.99320 0.00440 0.00670 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2823 2823 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: PORTION OF DUES PAID TO AHCA, WHCA, AND WICAL EXPENDED FOR LOBBYING PURPOSES. 416932 416932 25827559 15257746 10569813 5167812 3396337 1771475 221831 214765 7066 12765286 DEFERRED REVENUE FROM ADVANCE FEES 3311125 ADDITIONAL PENSION LIABILITY 697634 DEFERRED COMPENSATION 118783 4127542 X 21922847 0 21922847 -20932 -20932 21901915 21934026 20932 20932 21913094 0 21913094 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF 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 CORPORATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS AT JUNE 30, 2013 AND 2012. TAX RETURNS FOR THE YEARS ENDED JUNE 30, 2010 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTIONS. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVENTORY COST OF GOODS SOLD -20,932. PART XII, LINE 2D - OTHER ADJUSTMENTS: INVENTORY COST OF GOODS SOLD 20,932. GOLF OUTING 85474 44554 40920 40920 HOLIDAY BAZAAR 14246 12330 1916 1916 99720 56884 42836 42836 42836 0 X X 0 1 0 0 0 0 0 0 0 RICHARD RAU 192738 0 24116 0 23241 0 3643 0 20444 0 264182 0 0 0 DENNIS FERGER 152995 0 12418 0 12538 0 1547 0 23084 0 202582 0 0 0 SUPPLEMENTAL INFORMATION PART III THE CORPORATION ALSO SPONSORS A DEFERRED COMPENSATION PROGRAM COVERING THE CHIEF EXECUTIVE OFFICER - RICHARD RAU. INVESTMENTS, INCLUDED IN ASSETS LIMITED AS TO USE, AND CORRESPONDING LIABILITIES TOTALING 118,783 AND 106,749 AT JUNE 30, 2013 AND 2012, RESPECTIVELY ARE INCLUDED IN THE BALANCE SHEET. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION IS A SPONSORED MINISTRY OF THE SCHOOL SISTERS OF ST. FRANCIS OF ST. JOSEPH'S CONVENT, MILWAUKEE, WISCONSIN, INC. U.S. PROVINCE (SSSF). THE ELECTED LEADERS OF THE SSSF AND ITS TREASURER SERVE AS CORPORATE MEMBERS AND EXERCISE CONTROL OF THIS SUBSIDIARY CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE CURRENT BOARD MEMBERS RECRUIT, ELECT, AND VOTE FOR NEW BOARD MEMBERS AND THE FINAL VOTE IS FROM THE SCHOOL SISTERS OF ST. FRANCIS. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD DOES MAKE SOME DECISIONS WITHOUT APPROVAL, HOWEVER, CERTAIN ITEMS REQUIRE FINAL APPROVAL BY THE SCHOOL SISTERS OF ST. FRANCIS (SSSF). THE SSSF HAVE THE POWER: TO SAFEGUARD THE PURPOSES OF THE CORPORATION AND TO ANNUALLY MEET WITH THE BOARD OF DIRECTORS AND REVIEW THE FUNCTION OF THE BOARD AND THE OPERATIONS OF THE CORPORATION IN ACCORD WITH THE SSSF PHILOSOPHY, VALUES AND HERITAGE. TO APPOINT MEMBERS TO THE BOARD OF DIRECTORS. TO SAFEGUARD ALL ACTIVITIES IN ACCORDANCE WITH THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH SERVICES AS PROMULGATED BY THE NATIONAL CONFERENCE OF CATHOLIC BISHOPS. TO APPROVE THE STATEMENTS OF PHILOSOPHY AND MISSION OF THE CORPORATION TO AMEND, RESTATE, OR MODIFY THE ARTICLES OF INCORPORATIONS AND THE BYLAWS OF THE CORPORATION. TO APPROVE BYLAWS OF ALL ORGANIZATIONS UNDER THE AUSPICES OF THE CORPORATION. TO APPOINT AND TERMINATE THE CEO OF THE CORPORATION, AND BE CONSULTED PRIOR TO THE APPOINTMENT OF OTHER ADMINISTRATORS. TO APPROVE CAPITAL AND OPERATING BUDGETS FOR THE CORPORATION. TO APPROVE ANY CONTRACT UNDERTAKEN WITH A MANAGEMENT FIRM FOR GENERAL ADMINISTRATION SERVICES OR FULL OPERATION OF THE CORPORATION. TO DESIGNATE THE AUDITING FIRM REQUIRED FOR INSTITUTIONS SPONSORED BY SSSF. TO APPROVE ALL MAJOR (OVER $250,000) DEBT OBLIGATION INCURRED BY THE CORPORATION. TO APPROVE ALL MAJOR FUND DRIVES AND THE ESTABLISHMENT OF ENDOWMENTS. TO HOLD EXCLUSIVE AUTHORITY FOR THE DISSOLUTION, SALE PLEDGE, TRANSFER OR OTHER DISPOSITION OF THE ASSETS OF THE CORPORATION OR ITS MERGER WITH ANOTHER CORPORATION. TO APPOINT ONE SSSF TO SERVE ON ANY CEO SELECTION COMMITTEE. TO APPROVE THE COMPENSATION AND FRINGE BENEFITS PROGRAM FOR THE CEO. FORM 990, PART VI, SECTION B, LINE 11 ONCE CLEMENT MANOR RECEIVES THE COMPLETED 990, THEY WILL SEND A COPY TO THE EXECUTIVE COMMITTEE OF THEIR BOARD OF DIRECTORS. IT WILL THEN BE DISCUSSED AND APPROVED AT A BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C CLEMENT MANOR HAS ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES SIGN THE CONFLICT OF INTEREST STATEMENTS ANNUALLY, DISCLOSING ALL CONFLICTS OF INTEREST. CONFLICT OF INTEREST POLICY: DIRECTORS, OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS SHALL NOT DIVULGE OR COMMUNICATE TO ANY PERSON(S) ANY CONFIDENTIAL INFORMATION OF ANY KIND CONCERNING ANY MATTERS AFFECTING OR RELATING TO THE BUSINESS OF CLEMENT MANOR AND ITS PARTICIPATING ORGANIZATIONS. IF ONE IS NOT SURE IF INFORMATION IS CONFIDENTIAL, SUCH PERSON SHOULD REQUEST A DETERMINATION BY THE BOARD, THE CHAIRPERSON OF THE BOARD OR THE PRESIDENT, CEO OR ADMINISTRATOR. TRANSACTIONS INVOLVING CONFLICTS OF INTEREST INCLUDE, BUT ARE NOT LIMITED TO: 1. THE SALE, PURCHASE, LEASE OR RENTAL OF ANY PROPERTY OR OTHER ASSET; 2. EMPLOYMENT, OR RENDITION OF SERVICES, PERSONAL OR OTHERWISE; 3. THE AWARD OF ANY GRANT, CONTRACT, OR SUBCONTRACT; OR 4. THE INVESTMENT OR DEPOSIT OF ANY FUNDS OF THE CORPORATION. THIS PROHIBITION SHALL NOT, HOWEVER, PREVENT THE DISCLOSURE OF CONFIDENTIAL INFORMATION TO AN OFFICER OR DIRECTOR OR AN ORGANIZATION THAT CONTROLS CLEMENT MANOR. CONFLICT OF INTEREST PROCEDURES: 1. EVERY DIRECTOR, OFFICER, AND EMPLOYEE IS FAMILIARIZED WITH THE CONFIDENTIALITY POLICY DURING THEIR ORIENTATION PERIOD OR PRIOR TO ASSUMING THEIR DUTIES OR TERMS OF OFFICE. 2. WHENEVER A DIRECTOR, OFFICER, OR EMPLOYEE FEELS THAT A CONFLICT OF INTEREST SITUATION IS OR MAY BE INVOLVED, THE FACTS ARE TO BE PROMPTLY DISCLOSED. A) IN THE CASE OF AN EMPLOYEE: THE FACTS SHOULD BE KNOWN TO THE CHIEF EXECUTIVE OFFICER. B) IN THE CASE OF A DIRECTOR THE FACTS SHOULD BE KNOWN TO THE PRESIDENT OF THE BOARD OF DIRECTORS. THEREAFTER, THE DIRECTOR SHALL REFRAIN FROM DISCUSSING OR VOTING ON THE PARTICULAR TRANSACTION IN WHICH HE HAS AN INTEREST OR OTHERWISE ATTEMPTING TO EXERT ANY INFLUENCE ON THE CORPORATION, ITS BOARD OF DIRECTORS, OR ITS COMMITTEES, TO AFFECT ITS DECISION TO PARTICIPATE IN SUCH TRANSACTION. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE, AND THE ABSTENTION FROM DISCUSSION AND VOTING ON THE PARTICULAR TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE CEO, CFO AND OTHER KEY MANAGEMENT STAFF REVIEWS ALL EMPLOYEES WAGES AND THE BOARD COMPENSATION COMMITTEE REVIEWS THE CEO'S SALARY WITHOUT CONFLICT OF INTEREST. CLEMENT MANOR HAS ESTABLISHED WAGE RANGES FOR EVERY POSITION. EVERY YEAR, THEY COMPARE THE JOB RANGES TO A WAGE SURVEY THAT WAHSA PUTS TOGETHER. CLEMENT MANOR'S GOAL IS TO REMAIN AROUND THE 75TH PERCENTILE OF THE SURVEY. IF THEY ARE BELOW, THE CEO, CFO, AND OTHER KEY MANAGEMENT STAFF DECIDES IF THEY NEED TO INCLUDE AN ADJUSTMENT TO THE WAGE RANGE. THEY THEN INCLUDE THE FISCAL IMPACT IN THE BUDGET TO BE APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL MAKE THEIR GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G NURSING SERVICES: PROGRAM SERVICE EXPENSES 313,480. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 313,480. THERAPY SERVICES: PROGRAM SERVICE EXPENSES 1,310,919. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,310,919. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 49,657. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,657. RELIGIOUS SERVICES: PROGRAM SERVICE EXPENSES 12,249. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,249. CLEANING/LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 39,671. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,671. MAINTENANCE SERVICES/AGREEMENTS: PROGRAM SERVICE EXPENSES 315,717. MANAGEMENT AND GENERAL EXPENSES 316,961. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 632,678. CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 12,234. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,234. DATA PROCESSING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 7,278. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,278. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: UNFUNDED PENSION OBLIGATION 130,820. OVERSIGHT OF AUDIT FORM 990, PART XI, LINE 2C THE FINANCE COMMITTEE OF THE BOARD APPROVE THE AUDITING FIRM FOR THE CORPORATION AND ANY OF ITS AFFILIATED ENTITIES, AND ACCEPT THE AUDIT REPORT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. THE SCHOOL SISTERS OF ST FRANCIS OF ST JOSEPH'S CONVENT 1501 S LAYTON BLVD MILWAUKEE WI 53215 390806266 RELIGIOUS ORDER WI 501(C)(3) 1 N/A 0 MARYHILL MANOR 501 MADISON AVENUE NIAGARA WI 54151 391501353 NURSING HOME WI 501(C)(3) 9 SCHOOL SISTERS OF ST FRANCIS 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0