2012-03-12T04:56:22-05:00 2011-06-30 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2010-07-01 391020547 CLEMENT MANOR INC CLEM 4143211800 3939 S 92ND ST GREENFIELD WI 53228 DENNIS FERGER 4143211800 2012-03-03 1 TERRI REXRODE CPA MST 9206620016 2012-03-03 2010 2016-02-24 21:20:13Z DENNIS FERGER 3939 S 92ND ST GREENFIELD WI 53228 20765692 0 0928 X N/A 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. 14 13 427 107 0 0 167007 105840 20052276 20519091 288983 53297 22997 24436 20531263 20702664 0 0 0 0 12093118 12383708 0 0 61023 8030708 8097724 20123826 20481432 407437 221232 21455396 20090273 23011616 20821915 -1556220 -731642 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 17670081 20101098 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 2011 WAS APPROXIMATELY $2,964,000IN ADDITION CLEMENT PROVIDED APPROXIMATELY $39,000 OF CHARITY CARE SERVICES TO THE NEEDY IN FISCAL 2010. 17670081 1 1 0 1 0 0 0 0 0 1 1 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 0 0 0 0 1 24 0 1 427 1 0 0 0 0 0 1 1 0 0 0 0 X 14 13 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X DENNIS FERGER AND DIANE LEPKOWSKI 4143211800 3939 SOUTH 92ND STREET GREENFIELD WI 53228 THOMAS M GAZZANA 0.30 X 0 0 0 KRISTY A NIELSEN PHD 0.30 X X 0 0 0 SISTER JUDEEN SCHULTE 0.30 X X 0 0 0 WILLIAM BAZEN 0.30 X 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 LINDA SCHEIBLE 0.30 X 0 0 0 SISTER MARY YANNY 0.30 X 0 0 0 STEVE SKORONSKI 0.30 X X 0 0 0 JODIE LANE 0.30 X 0 0 0 RICHARD RAU 40.00 X X 252386 0 28441 KEVIN NITKA 0.30 X 0 0 0 SISTER CAROL GRANDLICH 0.30 X 0 0 0 DENNIS FERGER 40.00 X 183263 0 27407 LINDA STRUHAR 40.00 X 113155 0 21832 548804 0 77680 3 0 1 0 REHABCARE GROUP 7733 FORSYTH BLVD ST LOUIS MO 63105 THERAPY SERVICES 1344922 ROESCHEN INTERMED PHARMACY 3433 DOUGLAS AVE RACINE WI 53402 PHARMACY SERVICES 388834 EPPSTEIN UHEN 333 E CHICAGO ST MILWAUKEE WI 53202 ARCHITECTS 159936 3 49836 56004 105840 RESIDENT SERVICE REVEN 623000 19040161 19040161 RESIDENT ADMINISTRATIV 623000 662705 662705 DAYCARE REVENUE 623000 288854 288854 MISCELLANEOUS RESIDENT 623000 215158 215158 BEAUTY/BARBER SHOP REV 623000 117474 117474 194739 109378 85361 20519091 53297 53297 18549 18549 18549 18549 42277 49836 42277 0 26638 20751 5887 5887 20702664 20101098 0 495726 491497 491497 9402232 8445692 904955 51585 314724 274709 40015 1477285 1311652 165633 697970 599198 95232 3540 58730 58730 25170 25170 2133527 1831605 301922 2064801 1666349 398239 213 1583777 1583777 24044 20641 3403 29084 24968 4116 1242993 1242993 168232 168232 MISCELLANEOUS 663898 565029 93184 5685 BAD DEBT EXPENSE 103468 103468 20481432 17670081 2750328 61023 4005544 1966469 1155177 0 1561855 1396579 81518 77049 172465 73527 29830112 16177783 11292920 13652329 2743068 2494302 442849 430018 21455396 20090273 2307693 2031813 15529937 14615437 5173986 4174665 23011616 20821915 X -1556220 -731642 -1556220 -731642 21455396 20090273 X 221232 603346 X X 0 1 1 X 0 X 205988 184194 313577 167007 105840 976606 17641940 18481049 18665627 19635797 20101098 94525511 504040 480416 486908 1471364 17847928 18665243 19483244 20283220 20693846 96973481 5000 5001 5000 5000 20001 0 5000 5001 5000 5000 20001 96953480 261886 260140 181252 117811 71846 892935 261886 260140 181252 117811 71846 892935 18109814 18925383 19664496 20401031 20765692 97866416 0.99070 0.98920 0.00910 0.01080 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2697 2697 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: PORTION OF DUES PAID TO AHCA, WHCA, AND WICAL EXPENDED FOR LOBBYING PURPOSES. 416932 416932 21324478 13425079 7899399 4449200 2573578 1875622 3639502 179126 3460376 13652329 BOND INTEREST FUND 282805 F BOND PRINCIPAL FUND 604167 F 1998 DEBT SERVICE RESERVE FUND 1607330 F 2494302 DEFERRED REVENUE FROM ADVANCE FEES 3552419 ADDITIONAL PENSION LIABILITY 514196 DEFERRED COMPENSATION 108050 4174665 20702664 20481432 221232 -6327 609673 603346 824578 20723415 0 20723415 -20751 -20751 20702664 20502183 20751 20751 20481432 0 20481432 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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. TAX RETURNS FOR THE YEARS ENDED 2008 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE APPLICABLE TAXING AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: EXCESS UNFUNDED PENSION OBLIGATION 609,673. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVENTORY COST OF GOODS SOLD -20,751. PART XIII, LINE 2D - OTHER ADJUSTMENTS: INVENTORY COST OF GOODS SOLD 20,751. GOLF OUTING 77345 35068 42277 42277 HOLIDAY BAZAAR 13937 13937 91282 49005 42277 42277 42277 0 X X 0 0 0 0 0 0 0 0 0 RICHARD RAU 192580 0 35517 0 24289 0 3721 0 24720 0 280827 0 0 0 DENNIS FERGER 146737 0 16828 0 19698 0 1547 0 25860 0 210670 0 0 0 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 CFO 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. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE 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 EXECUTIVE COMMITTEE 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -6,327. EXCESS UNFUNDED PENSION OBLIGATION 609,673. TOTAL TO FORM 990, PART XI, LINE 5: 603,346. OVERSIGHT OF AUDIT FORM 990, PART XI, LINE 2C THE SCHOOL SISTERS OF ST. FRANCIS AND THE FINANCE COMMITTEE OF THE BOARD SELECT THE COMPANY THAT PERFORMS THE AUDIT AND THE FINANCE COMMITTEE OF THE BOARD OVERSEES THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. SCHOOL SISTERS OF ST FRANCIS 1501 S LAYTON BLVD MILWAUKEE WI 53215 391594407 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 N/A 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0