FOND DU LAC LUTHERAN HOME INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
FOND DU LAC LUTHERAN HOME INC (EIN 39-0806344)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-08-06
IRS object ID
201242199349301204
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-06T14:46:17-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN390758449EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 8010AddressLine1
CityWAUSAUCity
StateWIState
ZIP Code544028010ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN390806344EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FOND DU LAC LUTHERAN HOME INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFONDNameControl
Phone9209219520Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1244 N MACY STREETAddressLine1
CityFOND DU LACCity
StateWIState
ZIP Code549353393ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGARY WAGNERName
TitleCFOTitle
Phone9209219520Phone
Date Signed2012-07-31DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKIMBERLY HELLER CPAName
PTINP00766668PTIN
Phone7158453111Phone
Date Prepared2012-07-20DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGARY WAGNERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1244 N MACY STREETAddressLine1
CityFOND DU LACCity
StateWIState
ZIP Code549353393ZIPCode
FieldValueIRS element (for citing)
Gross Receipts9378606GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.LUTHERANHOMESFONDDULAC.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1939YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionFOND 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body3NbrVotingMembersGoverningBody
Nbr Independent Voting Members3NbrIndependentVotingMembers
Total Nbr Employees283TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year9399686ProgramServiceRevenuePriorYear
Program Service Revenue CY9373718ProgramServiceRevenueCY
Investment Income Prior Year9017InvestmentIncomePriorYear
Investment Income Current Year3048InvestmentIncomeCurrentYear
Other Revenue Prior Year39204OtherRevenuePriorYear
Other Revenue Current Year1840OtherRevenueCurrentYear
Total Revenue Prior Year9447907TotalRevenuePriorYear
Total Revenue Current Year9378606TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6615889SalariesEtcPriorYear
Salaries Etc Current Year5901792SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2949631OtherExpensePriorYear
Other Expenses Current Year3603290OtherExpensesCurrentYear
Total Expenses Prior Year9565520TotalExpensesPriorYear
Total Expenses Current Year9505082TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-117613RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-126476RevenuesLessExpensesCY
Total Assets BOY5733303TotalAssetsBOY
Total Assets EOY6329731TotalAssetsEOY
Total Liabilities BOY2256032TotalLiabilitiesBOY
Total Liabilities EOY1980793TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3477271NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4348938NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionFOND 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense8077598Expense
Revenue9350152Revenue
DescriptionLUTHERAN 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, ASSISTED LIVING AND WELLNESS PROGRAMMING 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 20,688 MEDICAID DAYS, 5,239 MEDICARE DAYS AND 41,025 TOTAL NURSING HOME DAYS IN 2011.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 11,151 BED DAYS IN 2011.Description
Total Program Service Expense8077598TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109615NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees283NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members3NbrVotingGoverningBodyMembers
Number Independent Voting Members3NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1GARY WAGNER CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9209219520TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1244 N MACY STREETAddressLine1
CityFOND DU LACCity
StateWIState
ZIP Code54935ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (5 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
JACK POLLEI 2013
SECRETARY1.00XX000
MARTIN RYAN 2013
CHAIRPERSON1.00XX000
KIM SUHS 2011
TREASURER1.00XX000
MARI BETH BOREK
CEO10.00X322909687123213
GARY WAGNER
CFO25.00X51489277254833
FieldValueIRS element (for citing)
Total Reportable Comp From Org83779TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs124596TotalReportableCompFrmRltdOrgs
Total Other Compensation28046TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
VALLEY BAY THERAPY
3305C N BALLARD ROADAPPLETONWI54911CONTRACT THERAPY SERVICES764481
REINHART FOOD SERVICE LLC
2655 RICHMOND STREETSHAWANOWI54166FOOD SERVICES267874
WISCONSIN POWER AND LIGHT
PO BOX 3068CEDAR RAPIDSIA52406UTILITIES217068
ALLIANCE PHARMACY
407 PILOT CT STE 300WAUKESHAWI53188PHARMACY SERVICES191210
BAND BOX CLEANERS
PO BOX 299TOMAHWI54660LAUNDRY SERVICES111162
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
NURSING HOME62300046450334645033
NURSING HOME PRIVATE P62300036007233600723
RESIDENTIAL FACILITY62300010733291073329
BEAUTY SHOP REVENUE9000003106731067
MISC REVENUE90000023566$23,566
FieldValueIRS element (for citing)
Total Program Service Revenue9373718TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3048TotalRevenueColumn
Exclusion$3,048ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory1840GrossSalesOfInventory
Cost Of Goods Sold0CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column1840TotalRevenueColumn
Exclusion$1,840ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column9378606TotalRevenueColumn
Related Or Exempt Function Income9350152RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$28,454ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total92723Total
Management And General92723ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4678722Total
Program Services4293574ProgramServices
Management And General385148ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total83329Total
Program Services75776ProgramServices
Management And General7553ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total702550Total
Program Services644717ProgramServices
Management And General57833ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total344468Total
Program Services308248ProgramServices
Management And General36220ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total2598Total
Management And General2598ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total34541Total
Management And General34541ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1531126Total
Program Services1277162ProgramServices
Management And General253964ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total9086Total
Management And General9086ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total304881Total
Program Services279331ProgramServices
Management And General25550ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total2661Total
Program Services1771ProgramServices
Management And General890ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total71671Total
Program Services71671ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total396680Total
Program Services396680ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total64658Total
Management And General64658ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES60351558713716378
WMAP BED ASSESSMENT271320271320
MISCELLANEOUS1144525633158121
REPAIRS AND MAINTENANCE82482772905192

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total113619Total
Program Services7910ProgramServices
Management And General105709ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9505082Total
Program Services8077598ProgramServices
Management And General1427484ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY881853BOY
EOY554878EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY869617BOY
EOY1077750EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY8098BOY
EOY13397EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY52718BOY
EOY49861EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis12044678LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec9052267LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3322234BOY
EOY2992411EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY598783BOY
EOY1641434EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY5733303BOY
EOY6329731EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY635039BOY
EOY562202EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY1234002BOY
EOY1062087EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY386991BOY
EOY356504EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2256032BOY
EOY1980793EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3378103BOY
EOY3251627EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY99168BOY
EOY1097311EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3477271BOY
EOY4348938EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5733303BOY
EOY6329731EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-126476ReconcilationRevenueExpenses
Reconcilation Other Changes998143ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8566310CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9798662CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9817268CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9367679CurrentTaxYearMinus1Year
Current Tax Year9319085CurrentTaxYear
Total46869004Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years37144CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years39382CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year71299CurrentTaxYearMinus1Year
Current Tax Year60385CurrentTaxYear
Total208210Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8566310CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9835806CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9856650CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9438978CurrentTaxYearMinus1Year
Current Tax Year9379470CurrentTaxYear
Total47077214Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50947077214PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6791CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6182CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9017CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10059CurrentTaxYearMinus1Year
Current Tax Year3048CurrentTaxYear
Total35097Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6791CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6182CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9017CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10059CurrentTaxYearMinus1Year
Current Tax Year3048CurrentTaxYear
Total35097Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8573101CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9841988CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9865667CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9449037CurrentTaxYearMinus1Year
Current Tax Year9382518CurrentTaxYear
Total47112311Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99930PublicSupportPercentage509
Prior Year Support Percentage0.99900PriorYearSupportPercentage
Investment Income Percentage0.00070InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00100PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis60413InvestmentCostOrOtherBasis
Book Value60413BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis8460467InvestmentCostOrOtherBasis
Depreciation6105608Depreciation
Book Value2354859BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis3404067InvestmentCostOrOtherBasis
Depreciation2872172Depreciation
Book Value531895BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis119731InvestmentCostOrOtherBasis
Depreciation74487Depreciation
Book Value45244BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2992411TotalOfBookValueLandBuildings

Other Assets OtherAssets (6 entries)

DescriptionDescriptionBook ValueBookValue
INTEREST IN NET ASSETS OF FOUNDATION1097311
DEFERRED CHARGES, NET17822
UNEMPLOYMENT COMP DEPOSIT177631
DUE FROM LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION, INC.140448
DUE FROM LUTHERAN HOMES AND HEALTH SERVICES, INC.145588
DUE FROM ST. PETERS62634
FieldValueIRS element (for citing)
Total Book Value Other Assets1641434TotalBookValueOtherAssets
Total Revenue9378606TotalRevenue
Total Expenses9505082TotalExpenses
Excess Or Deficit For Year-126476ExcessOrDeficitForYear
Other$998,143OtherAmount
Total Adjustments998143TotalAdjustments
Excess Or Deficit Per FS871667ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt9378606TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal9378606RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9909378606TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt9505082TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal9505082ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9909505082TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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 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 2008 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY INTERNAL REVENUE SERVICE.
PART XI, LINE 8 - OTHER ADJUSTMENTS:CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 998,143.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonMARI BETH BOREKNamePerson
Base Compensation Filing Org32290BaseCompensationFilingOrg
Comp Based On Related Orgs96871CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org1012DeferredCompFilingOrg
Deferred Comp Related Orgs3035DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org4791NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs14375NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org38093TotalCompensationFilingOrg
Total Compensation Related Orgs114281TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6FOND 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 7ATHE SOLE MEMBER ELECTS THE MEMBERS OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION A, LINE 7BDECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY ITS MEMBER.
FORM 990, PART VI, SECTION B, LINE 11A 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 12CWRITTEN 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 15THERE 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 19GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 5:CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 998,143. TOTAL TO FORM 990, PART XI, LINE 5: 998,143.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2CTHE 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. PERIODIC REVIEW OF AUDITOR SELECTION WITH ANNUAL REVIEW OF THE AUDIT ENGAGEMENT LETTER. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, PART VIILUTHERAN HOMES AND HEALTH SERVICES, INC. AND FOND DU LAC LUTHERAN HOME, INC. HAVE FORMED A COMMON PAY MASTER. MARI BETH BOREK'S SALARY IS PAID BY FOND DU LAC LUTHERAN HOME THROUGH COMMON PAY MASTER, BUT IS DEEMED PAID BY LUTHERAN HOMES AND HEALTH SERVICES, INC.
FORM 990, PART VII, LINE 1AMARI BETH BOREK DEVOTES APPROXIMATELY 30 HOURS PER WEEK AS FOLLOWS: LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION, INC. - 10 HOURS LUTHERAN HOMES AND HEALTH SERVICES, INC. - 20 HOURS GARY WAGNER DEVOTES APPROXIMATELY 15 HOURS PER WEEK AS FOLLOWS: LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION, INC. - 5 HOURS LUTHERAN HOMES AND HEALTH SERVICES, INC. - 10 HOURSEXPLANATION FOR HOURS WORKED

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
LUTHERAN HOMES AND HEALTH SERVICES INC
244 N MACY STREETFOND DU LACWI54935392032901PROVIDE MANAGEMENT SERVICES TO FOND DU LAC LUTHERAN HOME, INC.WI501(C)(3)LINE 9N/A0
LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION INC
244 N MACY STREETFOND DU LACWI54935391466308FUND DEVELOPMENTWI501(C)(3)LINE 90LUTHERAN HOMES AND HEALTH SERVICES INC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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