2013-08-30T08:54:21-05:00 2012-12-31 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2012-01-01 390806344 FOND DU LAC LUTHERAN HOME INC FOND 9209219520 244 N MACY STREET FOND DU LAC WI 549353393 GARY WAGNER 9209219520 2013-08-29 1 KIMBERLY HELLER CPA P00766668 7158453111 2013-08-29 2012 2016-02-24 21:20:13Z GARY WAGNER 244 N MACY STREET FOND DU LAC WI 549353393 8312727 0 X WWW.LUTHERANHOMESFONDDULAC.ORG X 1939 WI 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. 3 3 288 0 0 0 0 0 9373718 8258260 3048 -4291 1840 962 9378606 8254931 0 0 0 0 5901792 5437254 0 0 0 3603290 3242060 9505082 8679314 -126476 -424383 6329731 5773959 1980793 1845517 4348938 3928442 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 7055403 8220073 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.SKILLED NURSING: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 24,589 MEDICAID DAYS, 4,005 MEDICARE DAYS AND 36,871 TOTAL NURSING HOME DAYS IN 2012.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 10,971 BED DAYS IN 2012. 7055403 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 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 13 0 1 288 1 0 0 0 0 0 0 0 0 0 0 X 3 3 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 WI X X X GARY WAGNER CFO 9209219520 244 N MACY STREET FOND DU LAC WI 54935 X JACK POLLEI 2013 1.00 X X 0 0 0 MARTIN RYAN 2013 1.00 X X 0 0 0 KIM SUHS 2011 1.00 X X 0 0 0 MARI BETH BOREK 10.00 30.00 X 33082 99246 17343 GARY WAGNER 25.00 15.00 X 49938 29962 2416 DEBRA BARTH 40.00 0.00 X 85486 0 13705 168506 129208 33464 0 0 0 0 VALLEY BAY THERAPY 3305C N BALLARD ROAD APPLETON WI 54911 CONTRACT THERAPY SERVICES 545711 REINHART FOOD SERVICE LLC 2655 RICHMOND STREET SHAWANO WI 54166 FOOD SERVICES 259264 ALLIANCE PHARMACY 407 PILOT CT STE 300 WAUKESHA WI 53188 PHARMACY SERVICES 182411 GULF SOUTH PO BOX 841968 DALLAS TX 75284 NURSING SUPPLIES 127336 BAND BOX PO BOX 299 TOMAH WI 54660 LAUNDRY SERVICES 100036 5 NURSING HOME 623000 4042148 4042148 NURSING HOME PRIVATE P 623000 3083242 3083242 RESIDENTIAL FACILITY 623000 1094683 1094683 BEAUTY SHOP REVENUE 900000 25260 25260 MISC REVENUE 900000 12927 12927 8258260 1201 1201 52304 57796 -5492 -5492 -5492 962 0 962 962 8254931 8220073 0 34858 X 188057 188057 4297013 3979921 317092 34946 28026 6920 593024 415117 177907 324214 282768 41446 5732 5732 32531 32531 1274000 945951 328049 8694 8694 256789 234899 21890 5428 3170 2258 62651 62651 411613 411613 72412 72412 SUPPLIES 561917 548210 13707 WMAP BED ASSESSMENT 271320 271320 MISCELLANEOUS 92957 67310 25647 REPAIRS AND MAINTENANCE 64603 54982 9621 121413 20785 100628 8679314 7055403 1623911 0 554878 368321 1077750 1065651 13397 9245 49861 41820 11939815 9273389 2992411 2666426 1641434 1622496 6329731 5773959 562202 635511 1062087 887494 356504 322512 1980793 1845517 X 3251627 2879548 1097311 1048894 4348938 3928442 6329731 5773959 X -424383 3887 X X 0 1 X 1 0 X 9798662 9817268 9367679 9319085 8220073 46522767 37144 39382 71299 60385 39149 247359 9835806 9856650 9438978 9379470 8259222 46770126 0 0 0 46770126 6182 9017 10059 3048 1201 29507 6182 9017 10059 3048 1201 29507 9841988 9865667 9449037 9382518 8260423 46799633 0.99940 0.99930 0.00060 0.00070 X 60413 60413 8512671 6377114 2135557 3247000 2819250 427750 119731 77025 42706 2666426 INTEREST IN NET ASSETS OF FOUNDATION 1048894 DEFERRED CHARGES, NET 15049 UNEMPLOYMENT COMP DEPOSIT 177631 DUE FROM LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION, INC. 142554 DUE FROM LUTHERAN HOMES AND HEALTH SERVICES, INC. 148534 DUE FROM ST. PETERS PLACE LLC 89834 1622496 X 8254931 0 8254931 0 8254931 8679314 0 8679314 0 8679314 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 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. MANAGEMENT DOES NOT BELIEVE LUTHERAN HOME HAS ANY MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOQNIZED TAX BENEFITS. LUTHERAN HOME'S FEDERAL RETURNS FOR TAX YEARS 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION A, LINE 6 FOND DU LAC LUTHERAN HOME, INC. HAS A SINGLE CLASS OF MEMBERS, AND THE SOLE MEMBER OF THAT CLASS IS LUTHERAN HOMES AND HEALTH SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER ELECTS THE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY ITS MEMBER. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO SUBCOMMITTEES OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT COPY OF THE TAX RETURN IS PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW BEFORE IT IS FINALIZED. FORM 990, PART VI, SECTION B, LINE 12C WRITTEN DISCLOSURE COMPLETED ANNUALLY AND SHARED WITH THE BOARD, MEMBERS DISCLOSE POTENTIAL CONFLICTS AT THE TIME OF DISCUSSION AND STATES CASE. THE MEMBER IS THEN EXCUSED BY THE BOARD CHAIR WHILE THE BOARD DETERMINES IF A CONFLICT EXISTS. A MEMBER IS ABSTAINED FROM VOTING IF THERE IS DEEMED TO BE A CONFLICT. ALL BOARD MINUTES REFLECT DISCLOSURE AND ACTIONS TAKEN. FORM 990, PART VI, SECTION B, LINE 15 THERE IS AN ANNUAL WRITTEN EVALUATION COMPLETED BY EACH LUTHERAN HOMES AND HEALTH SERVICES BOARD MEMBER. THE BOARD THEN DISCUSSES PERFORMANCE IN EXECUTIVE SESSION AND THE EXECUTIVE COMMITTEE RECOMMENDS COMPENSATION BASED ON CURRRENT COMPARABILITY DATA AND PERFORMANCE OBJECTIVES. THE CEO DOES AN ANNUAL WRITTEN EVALUATION AND THE AMOUNT OF COMPENSATION IS BASED ON THE CURRENT AREA COMPARABILITY DATA, ANNUAL EVALUATION, AND PERFORMANCE OBJECTIVES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII LUTHERAN HOMES AND HEALTH SERVICES, INC., LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION, INC., AND FOND DU LAC LUTHERAN HOMES, INC. HAVE FORMED A COMMON PAY MASTER. MARI BETH BOREK'S, GARY WAGNER'S, AND DEBRA BARTH'S SALARY ARE PAID BY FOND DU LAC LUTHERAN HOME THORUGH COMMON PAY MASTER, BUT IS DEEMED PAID BY LUTHERAN HOMES AND HEALTH SERVICES, INC. AND LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION, INC. OTHER FEES FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 943,178. MANAGEMENT AND GENERAL EXPENSES 316,938. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,260,116. PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 11,111. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,111. AMORTIZATION EXPENSE: PROGRAM SERVICE EXPENSES 2,773. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,773. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 3,887. 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 FINANCIAL 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. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR 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 INACTIVE WI 501(C)(3) LINE 9 LUTHERAN HOMES AND HEALTH SERVICES INC 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 1 0 0