2014-05-14T15:55:37-05:00 2013-12-31 810385940 ANDERSON ZURMUEHLEN & CO PC PO BOX 748 BUTTE MT 59703 990 2013-01-01 364016275 WISCONSIN ILLINOIS SENIOR HOUSING INC WISC 2627288167 13185 W GREEN MOUNTAIN DRIVE LAKEWOOD CO 80228 ANDY KERWIN SECRETARY 2627288167 2014-04-25 1 JAMES E WOY P00102054 4067820451 2014-04-25 2013 2015-11-30 17:44:51Z ANDY KERWIN 13185 W GREEN MOUNTAIN DRIVE LAKEWOOD CO 80228 41716602 0 X WWW.WISCONSINILLINOISSENOIRHOUSING.ORG X 1994 IL SKILLED NURSING AND ASSISTED LIVING FACILITIES. 7 7 1342 0 0 0 864446 35682 33464363 41443208 221403 106314 -754905 -4569 33795307 41580635 0 0 0 0 18375806 23254706 0 0 0 15902066 17620144 34277872 40874850 -482565 705785 58536875 65197172 53327400 59327055 5209475 5870117 THE PRIMARY PURPOSE IS TO PROVIDE SKILLED NURSING AND ASSISTED LIVING FACILITIES FOR AGED INDIVIDUALS. 0 0 30525109 35679826 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, AND MONTELLO CARE CENTER--50 BED SKILLED NURSING AND 14 BED COMMUNITY BASED RESIDENTIAL FACILITY. 4565190 5513382 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. 35090299 1 0 0 0 0 0 0 0 0 0 1 0 1 1 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 68 0 1 1342 1 0 0 0 0 0 0 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 MIRIAM GEHLER MEMBER 1.00 X 0 0 0 ANDREW KERWIN SECRETARY 1.00 X X 0 0 0 JILL KRUEGER TREASURER 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 0 0 0 0 0 0 0 GENESIS REHAB SERVICES PO BOX 7247-6524 PHILADELPHIA PA 191706524 THERAPY SERVICES 2232045 CARRIAGE HEALTHCARE INC 13185 W GREEN MTN DRIVE LAKEWOOD CO 80228 MANAGEMENT COMPANY 1661675 MARTIN BROS PO BOX 69 CEDAR FALLS IA 50613 FOOD SERVICES 602304 MEDLINE INDUSTRIES PO BOX 121080 DALLAS TX 75312 MEDICAL SUPPLIES 332881 REINHART 2655 EAST RICHMOND STREET SHWNO WI 51466 FOOD SERVICES 283887 5 35682 35682 RESIDENT CARE REVENUE 623000 27340700 27340700 ANCILLIARY REVENUE 623000 7682117 7682117 ASSISTED LIVING REVENUE 623000 5971601 5971601 RECOVERY OF SHELTERED VILLAGE DIS 623000 250000 250000 MISC PATIENT BENEFIT REVENUE 623000 198790 198790 41443208 100930 100930 6000 10569 -4569 -4569 -4569 130782 125398 5384 5384 5384 41580635 41443208 0 101745 19867225 19648188 219037 1440275 1320191 120084 1947206 1825383 121823 1585970 1585970 128959 128959 258464 258464 24036 24036 59601 10050 49551 156324 62929 93395 1590306 1472551 117755 124362 19895 104467 2560374 106800 2453574 1488936 1488936 366691 366366 325 SUPPLIES 3444012 3442593 1419 PURCHASED SERVICES AND 3209331 2995848 213483 BUSINESS TAXES 976518 976518 BAD DEBT EXPENSE 453951 453951 1192309 744599 447710 40874850 35090299 5784551 0 5722 8374 3528961 4287285 6041589 4947310 85640 80024 44229 161120 48820634 10962232 32654800 37858402 1849368 1872712 12313567 13270727 2012999 2711218 58536875 65197172 6645636 5352919 46570057 53748516 171890 111707 53730 53327400 59327055 X 5209475 5870117 5209475 5870117 58536875 65197172 705785 -45143 0 X X 0 1 X 1 0 X 19999 39569 21937 57422 35682 174609 28822103 30421464 31588458 33464363 41187684 165484072 28842102 30461033 31610395 33521785 41223366 165658681 0 0 0 165658681 83860 190842 139265 534803 112430 1061200 83860 190842 139265 534803 112430 1061200 28925962 30651875 31749660 34056588 41335796 166719881 0.99360 0.99240 0.00640 0.00760 X 3137774 3137774 45682860 10962232 34720628 37858402 RESTRICTED BOND RESERVES 13270727 F 13270727 RESIDENT TRUST ACCOUNTS 53730 53730 X 36947400 -45143 -4598977 -4644120 41591520 -10885 -10885 41580635 36286200 7418 7418 36278782 4596068 4596068 40874850 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) $453,951 - PROVISION FOR BAD DEBT IS PRESENTED IN PATIENT REVENUES FOR FINANCIAL REPORTING PRESENTATION. ADJUSTMENT (2) $4,142,117 - FINANCIAL STATEMENTS INCLUDED THIS MUCH OF ANCILLARY EXPENSES REVENUES. ADJUSTMENT (3) $2,909- CLASSIFICATION DIFFERENCE BETWEEN REVENUE AND EXPENSE. PART XI, LINE 4B ADJUSTMENT (1) -$10,565 - RENTAL EXPENSE IS REPORTED IN REVENUES ON THE FORM 990. ADJUSTMENT (2) -$316 ROUNDING DIFFERENCE. PART XII, LINE 2D ADJUSTMENT (1) -$2,909 - CLASSIFICATION DIFFERENCE BETWEEN REVENUE AND EXPENSE. ADJUSTMENT (2) $242 - ROUNDING TO THE AUDITED FINANCIAL STATEMENTS. ADJUSTMENT (3) $10,569 - RENTAL EXPENSE IS REPORTED IN REVENUE ON THE FORM 990. PART XII, LINE 4B ADJUSTMENT (1) $453,951 - THE PROVISION FOR BAD DEBT IS INCLUDED IN EXPENSES ON THE FORM 990. ADJUSTMENT (2) $4,142,117 - FINANCIAL STATEMENTS INCLUDED THIS MUCH OF ANCILLARY EXPENSES REVENUES. A WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710VJ84 2006-07-19 330000 DEBT PREVIOUSLY FINANCED FOR ACQUISITION OF FIVE NURSING HOME FACILITIES 0 0 0 B WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710VH92 2006-07-19 345000 DEBT PREVIOUSLY FINANCED FOR ACQUISITION OF FIVE NURSING HOME FACILITIES 0 0 0 C WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710VJ66 2003-07-19 2020000 DEBT PREVIOUSLY FINANCED FOR ACQUISITION OF FIVE NURSING HOME FACILITIES 0 0 0 D WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710VJ74 2006-07-19 2655000 DEBT PREVIOUSLY FINANCED FOR ACQUISITION OF FIVE NURSING HOME FACILITIES 0 0 0 A 2006 0 0 0 0 B 2006 0 0 0 0 C 2006 0 0 0 0 D 2006 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 97710VJ82 2006-07-19 7170000 DEBT PREVIOUSLY FINANCED FOR ACQUISITION OF FIVE NURSING HOME FACILITIES 0 0 0 B WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710V4B1 2007-09-07 585000 ACQUISITION OF SIX ASSISTED LIVING FACILITIES LOCATED IN WISCONSIN 0 0 0 C WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710V460 2007-09-17 1130000 ACQUISITION OF SIX ASSISTED LIVING FACILITIES LOCATED IN WISCONSIN 0 0 0 D WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710V4H8 2007-09-17 3605000 ACQUISITION OF SIX ASSISTED LIVING FACILITIES LOCATED IN WISCONSIN 0 0 0 A 2006 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 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 9771044J4 2007-09-17 7935000 ACQUISITION OF SIX ASSISTED LIVING FACILITIES LOCATED IN WISCONSIN 0 0 0 B WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 977108VD1 2010-08-01 980000 REFINANCE AND IMPROVEMENTS OF LIVIING FACILITIES 0 0 0 C WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710BVE9 2010-08-01 1275000 REFINANCE AND IMPROVEMENTS OF LIVIING FACILITIES 0 0 0 D WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 977108BG4 2010-08-01 6910000 REFINANCE AND IMPROVEMENTS OF LIVIING FACILITIES 0 0 0 A 2007 0 0 0 0 B 2010 0 0 0 0 C 2010 0 0 0 0 D 2010 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 97710B2H4 2012-08-07 2070000 ACQUISITION OF 1 FACILITY LOCATED IN WISCONSIN AND IMPROVEMENTS OF LIVING FA 0 0 0 B 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 C 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 D 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 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 97710B2A9 2012-08-07 230000 ACQUISITION OF 1 FACILITY LOCATED IN WISCONSIN AND IMPROVEMENTS OF LIVING FA 0 0 0 B 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 C 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 D 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 A 2012 0 0 0 0 B 2012 0 0 0 0 C 2012 0 0 0 0 D 2015 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 97710B2E1 2012-08-07 265000 ACQUISITION OF 1 FACILITY LOCATED IN WISCONSIN AND IMPROVEMENTS OF LIVING FA 0 0 0 B 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 C 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 D WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DDD5 2013-11-06 430000 IMPROVEMENTS OF 1 FACILITY LOCATED IN WISCONSIN. 0 0 0 A 2012 0 0 0 0 B 2012 0 0 0 0 C 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 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 A 0 B 0 C 0 A WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DDJ2 2013-11-06 7525000 IMPROVEMENTS OF 1 FACILITY LOCATED IN WISCONSIN. 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS ENGAGED CARRIAGE HEALTHCARE INC. (CHC) TO PROVIDE MANAGEMENT SERVICES THROUGH JUNE 30, 2013. 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 - 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