2012-08-06T14:46:17-05:00 2011-12-31 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2011-01-01 390806344 FOND DU LAC LUTHERAN HOME INC FOND 9209219520 244 N MACY STREET FOND DU LAC WI 549353393 GARY WAGNER 9209219520 2012-07-31 1 KIMBERLY HELLER CPA P00766668 7158453111 2012-07-20 2011 2016-02-24 21:20:13Z GARY WAGNER 244 N MACY STREET FOND DU LAC WI 549353393 9378606 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 3 283 0 0 0 0 0 9399686 9373718 9017 3048 39204 1840 9447907 9378606 0 0 0 0 6615889 5901792 0 0 0 2949631 3603290 9565520 9505082 -117613 -126476 5733303 6329731 2256032 1980793 3477271 4348938 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 8077598 9350152 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, 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. 8077598 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 15 0 1 283 1 0 0 0 0 0 0 0 0 0 0 X 3 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X GARY WAGNER CFO 9209219520 244 N MACY STREET FOND DU LAC WI 54935 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 X 32290 96871 23213 GARY WAGNER 25.00 X 51489 27725 4833 83779 124596 28046 0 0 1 0 VALLEY BAY THERAPY 3305C N BALLARD ROAD APPLETON WI 54911 CONTRACT THERAPY SERVICES 764481 REINHART FOOD SERVICE LLC 2655 RICHMOND STREET SHAWANO WI 54166 FOOD SERVICES 267874 WISCONSIN POWER AND LIGHT PO BOX 3068 CEDAR RAPIDS IA 52406 UTILITIES 217068 ALLIANCE PHARMACY 407 PILOT CT STE 300 WAUKESHA WI 53188 PHARMACY SERVICES 191210 BAND BOX CLEANERS PO BOX 299 TOMAH WI 54660 LAUNDRY SERVICES 111162 5 NURSING HOME 623000 4645033 4645033 NURSING HOME PRIVATE P 623000 3600723 3600723 RESIDENTIAL FACILITY 623000 1073329 1073329 BEAUTY SHOP REVENUE 900000 31067 31067 MISC REVENUE 900000 23566 23566 9373718 3048 3048 1840 0 1840 1840 9378606 9350152 0 28454 92723 92723 4678722 4293574 385148 83329 75776 7553 702550 644717 57833 344468 308248 36220 2598 2598 34541 34541 1531126 1277162 253964 9086 9086 304881 279331 25550 2661 1771 890 71671 71671 396680 396680 64658 64658 SUPPLIES 603515 587137 16378 WMAP BED ASSESSMENT 271320 271320 MISCELLANEOUS 114452 56331 58121 REPAIRS AND MAINTENANCE 82482 77290 5192 113619 7910 105709 9505082 8077598 1427484 0 881853 554878 869617 1077750 8098 13397 52718 49861 12044678 9052267 3322234 2992411 598783 1641434 5733303 6329731 635039 562202 1234002 1062087 386991 356504 2256032 1980793 X 3378103 3251627 99168 1097311 3477271 4348938 5733303 6329731 X -126476 998143 X X 0 1 1 X 0 X 8566310 9798662 9817268 9367679 9319085 46869004 37144 39382 71299 60385 208210 8566310 9835806 9856650 9438978 9379470 47077214 0 0 0 47077214 6791 6182 9017 10059 3048 35097 6791 6182 9017 10059 3048 35097 8573101 9841988 9865667 9449037 9382518 47112311 0.99930 0.99900 0.00070 0.00100 X 60413 60413 8460467 6105608 2354859 3404067 2872172 531895 119731 74487 45244 2992411 INTEREST IN NET ASSETS OF FOUNDATION 1097311 DEFERRED CHARGES, NET 17822 UNEMPLOYMENT COMP DEPOSIT 177631 DUE FROM LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION, INC. 140448 DUE FROM LUTHERAN HOMES AND HEALTH SERVICES, INC. 145588 DUE FROM ST. PETERS 62634 1641434 9378606 9505082 -126476 998143 998143 871667 9378606 0 9378606 0 9378606 9505082 0 9505082 0 9505082 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. X X X 0 0 0 0 0 0 0 0 0 MARI BETH BOREK 32290 96871 0 0 0 0 1012 3035 4791 14375 38093 114281 0 0 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 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. CHANGES IN NET ASSETS OR FUND BALANCES: 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. 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. 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 VII LUTHERAN 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. EXPLANATION FOR HOURS WORKED FORM 990, PART VII, LINE 1A MARI 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 HOURS 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 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0