2014-08-29T08:21:56-05:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2013-01-01 390806344 FOND DU LAC LUTHERAN HOME INC FOND 9209219520 244 N MACY STREET FOND DU LAC WI 549353393 GARY WAGNER CFO 9209219520 2014-08-15 1 KIMBERLY ANDERSON CPA P00188889 6086628600 2014-08-15 2013 2015-11-30 17:44:51Z GARY WAGNER 244 N MACY STREET FOND DU LAC WI 549353393 9323900 0 X WWW.LUTHERANHOMESFONDDULAC.ORG X 1939 WI FOND DU LAC LUTHERAN HOME PROVIDES A CHRISTIAN-BASED INNOVATIVE APPROACH TO AGING THROUGH COMPREHENSIVE SERVICES, PROGRAMS, AND COMMUNITIES. 3 3 278 150 0 0 0 1300682 8258260 7967051 -4291 883 962 43913 8254931 9312529 0 0 0 0 5437254 5614511 0 0 0 3242060 2722349 8679314 8336860 -424383 975669 5773959 6552681 1845517 1643856 3928442 4908825 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 6422394 7987228 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 21,200 MEDICAID DAYS, 3,777 MEDICARE DAYS AND 32,945 TOTAL NURSING HOME DAYS IN 2013. 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 10,549 BED DAYS IN 2013. 6422394 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 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 31 0 1 278 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 X GARY WAGNER 9209219520 244 N MACY STREET FOND DU LAC WI 549353393 X TERRY SCHLEIF CHAIRPERSON 1.00 2.00 X X 0 0 0 DICK KLEINFELDT SECRETARY 1.00 2.00 X X 0 0 0 KIM SUHS TREASURER 1.00 2.00 X X 0 0 0 DEBRA BARTH COO 10.00 30.00 X 85616 0 7207 MARI BETH BOREK CEO 10.00 30.00 X 127050 0 6553 GARY WAGNER CFO 10.00 30.00 X 79667 0 780 DEAN DESILET OFFICER 10.00 30.00 X 0 0 27000 LAURA SCHWARTZBURG OFFICER 10.00 30.00 X 53233 0 7338 GARY THORPE OFFICER 10.00 30.00 X 61437 0 0 407003 0 48878 1 0 0 0 CD SMITH CONSTRUCTION PO BOX 1006 FOND DU LAC WI 54936 MAJOR REHAB PROJECT-BUILDING CONTRACTOR 1721115 HUMANA INC 1 WESTBROOK CORPORATE CENTER WESTCHESTER IL 60154 HEALTH AND DENTAL INSURANCE PROVIDER 575009 VALLEY BAY THERAPY INC 3305C NORTH BALLARD RD APPLETON WI 54911 THERAPY (PT, OT AND SPEECH) PROVIDER 458888 CONSOLIDATED MATERIALS LLC PO BOX 1006 FOND DU LAC WI 54936 MAJOR PROJECT-MATERIAL SUPPLIER 322718 REINHART FOOD SERVICE 2655 E RICHMOND ST SHAWANO WI 54166 FOOD AND RELATED SUPPLIER 255792 5 1200682 100000 1300682 NURSING HOME 623000 6853595 6853595 RESIDENTIAL FACILITY 623000 1087885 1087885 BEAUTY SHOP REVENUE 900099 25571 25571 7967051 883 883 9536 11371 -1835 -1835 MISC REVENUE 623000 45748 45748 45748 9312529 7987228 0 24619 113971 113971 4143307 3585160 558147 39574 11305 28269 493149 47801 445348 824510 754232 70278 30622 5031 25591 36537 3040 33497 608237 313472 294765 58712 51215 7497 56525 3196 53329 279568 279568 9412 5424 3988 53831 53831 390703 390703 70425 70425 SUPPLIES 578536 578536 0 WMAP BED ASSESSMENT 214200 0 214200 BAD DEBT EXPENSE 125629 125629 0 REPAIRS AND MAINTENANCE 41279 39927 1352 168133 60353 107780 8336860 6422394 1914466 0 368321 286627 1065651 0 0 842203 9245 41820 47211 14176852 9656080 2666426 4520772 1622496 855868 5773959 6552681 635511 607509 887494 531790 322512 503339 0 1218 1845517 1643856 X 2879548 4829717 1048894 79108 3928442 4908825 5773959 6552681 X 975669 4714 X X 0 1 X 1 0 X 1300682 1300682 9817268 9438978 9375558 8259222 7976587 44867613 39382 39382 9856650 9438978 9375558 8259222 9277269 46207677 0 0 0 46207677 9017 10059 3048 1201 883 24208 9017 10059 3048 1201 883 24208 45748 45748 9865667 9449037 9378606 8260423 9323900 46277633 0.99850 0.99940 0.00050 0.00060 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 60413 60413 8515865 6652565 1863300 3310584 2922935 387649 2289990 80580 2209410 4520772 INTEREST IN NET ASSETS OF FOUNDATION 79108 DEFERRED CHARGES, NET 12276 UNEMPLOYMENT COMP DEPOSIT 178299 DUE FROM LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION, INC 487469 DUE FROM LUTHERAN HOMES AND HEALTH SERVICES, INC 19965 DUE FROM ST PETERS PLACE LLC 78741 DUE FROM RETIREMENT HOUSING 10 855868 DUE TO THE HILLS AT CORTLAND RIDGE 1218 1218 9323900 11371 11371 9312529 0 9312529 8348231 11371 11371 8336860 0 8336860 PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOOD SOLD - GIFT SHOP 11,371. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOOD SOLD - GIFT SHOP 11,371. 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 DIRECTOS SHALL BE APPOINTED BY THE MEMBER WITH CONSIDERATION GIVEN TO THEIR CHARACTER, CONCERN FOR THE PRINCIPLES AND PROGRAMS OF THE CORPORATIN, AND THE SINGULAR CONTRIBUTIONS THEY COULD RENDER TO THE INCREASED EFFECTIVENESS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS 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 DEBRIEFED 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. 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 COMPARABILITY DATA: GEOGRAPHIC, REVENUES, BED/PROGRAM SIZE AS COMPARED WITH OTHER LIKE NOT FOR PROFIT AGING SERVICES PROVIDERS IN WI. DOCUMENTATION OF EXECUTIVE SESSION MINUTES ARE ON FILE WITH THE LHHS BOARD CHAIR AND THE EXECUTIVE ASSISTANT. KEY LEADERSHIP ROLES ARE EVALUATED, GENERALLY ANNUALY, WITH REVIEW OF POSITION DESCRIPTION, GOALS, OBJECTIVES AND WORK PLAN AND ASSOCIATED OUT COMES. KEY LEADERSHIP COMPENSATION IS BASED UPON COMARABILITY DATA AS NOTED ABOVE, AND IS DETERMINE BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 THE 990 IS AVAILABLE ON THE ORGANIZATIONS WEBSITE AND 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 DEAN DESILET'S, LAURA SCHWARTZBURG'S, GARY THORPE'S, MARI BETH BOREK'S, GARY WAGNER'S, AND DEBRA BARTH'S SALARY 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 4,714. 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 1 1 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0