CLEMENT MANOR INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
CLEMENT MANOR INC (EIN 39-1020547)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-01-25
IRS object ID
201100259349300100
Schema version
2009v1.7
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)
Timestamp2011-01-25T05:00:19-06:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 12237AddressLine1
CityGREEN BAYCity
StateWIState
ZIP Code543072237ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN391020547EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Clement Manor IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCLEMNameControl
Phone4143211800Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line13939 S 92nd StAddressLine1
CityGreenfieldCity
StateWIState
ZIP Code53228ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDENNIS FERGERName
TitleCFOTitle
Phone4143211800Phone
Date Signed2011-01-14DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTerri Rexrode CPA MSTName
Phone9206620016Phone
Date Prepared2011-01-14DatePrepared
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDennis FergerNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line13939 S 92nd StAddressLine1
CityGreenfieldCity
StateWIState
ZIP Code53228ZIPCode
FieldValueIRS element (for citing)
Gross Receipts20640023GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1963YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionCLEMENT 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 THIER 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees435TotalNbrEmployees
Total Nbr Volunteers115TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year313577ContributionsGrantsPriorYear
Contributions Grants Current Year167007ContributionsGrantsCurrentYear
Program Service Revenue Prior Year19096198ProgramServiceRevenuePriorYear
Program Service Revenue CY20052276ProgramServiceRevenueCY
Investment Income Prior Year163778InvestmentIncomePriorYear
Investment Income Current Year288983InvestmentIncomeCurrentYear
Other Revenue Prior Year29659OtherRevenuePriorYear
Other Revenue Current Year22997OtherRevenueCurrentYear
Total Revenue Prior Year19603212TotalRevenuePriorYear
Total Revenue Current Year20531263TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year11787501SalariesEtcPriorYear
Salaries Etc Current Year12093118SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year56820TotalFundrsngExpCurrentYear
Other Expense Prior Year7465350OtherExpensePriorYear
Other Expenses Current Year8030708OtherExpensesCurrentYear
Total Expenses Prior Year19252851TotalExpensesPriorYear
Total Expenses Current Year20123826TotalExpensesCurrentYear
Revenues Less Expenses Prior Year350361RevenuesLessExpensesPriorYear
Revenues Less Expenses CY407437RevenuesLessExpensesCY
Total Assets BOY21571910TotalAssetsBOY
Total Assets EOY21455396TotalAssetsEOY
Total Liabilities BOY23515172TotalLiabilitiesBOY
Total Liabilities EOY23011616TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-1943262NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-1556220NetAssetsOrFundBalancesEOY
Mission DescriptionCLEMENT 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense17100694Expense
Revenue19635797Revenue
DescriptionCLEMENT 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 2010 was approximately $2,989,000IN ADDITION CLEMENT PROVIDED APPROXIMATELY $74,000 OF CHARITY CARE SERVICES TO THE NEEDY IN FISCAL 2010.Description
Total Program Service Expense17100694TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
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 Activities1FundraisingActivities
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
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109644NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees435NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
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 Line1DENNIS FERGER and DIANE LEPKOWSKIBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4143211800TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13939 SOUTH 92ND STREETAddressLine1
CityGREENFIELDCity
StateWIState
ZIP Code53228ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
THOMAS M GAZZANA
VICE-CHAIR0.30XX000
KRISTY A NIELSON PHD
BOARD MEMBER0.30XX000
SISTER JUDEEN SCHULTE
SECRETARY0.30XX000
WILLIAM BAZAN
TREASURER0.30XX000
THOMAS R ALLEN
BOARD MEMBER0.30X000
SISTER HELEN BUTZLER
BOARD MEMBER0.30X000
SISTER JONEEN KEULER
BOARD MEMBER0.30X000
LINDA SCHEIBLE
BOARD MEMBER0.30X000
SISTER MARY YANNY
BOARD MEMBER0.30X000
STEVE SKORONSKI
CHAIR0.30X000
MICHAEL L JONES
BOARD MEMBER0.30X000
RICHARD RAU
CEO40.00XX258454025386
DENNIS FERGER
CFO/ADMINISTRATOR40.00181358025907X
LINDA STRUHAR
DIR OF NRSG40.00114288021641X
FieldValueIRS element (for citing)
Total Reportable Comp From Org554100TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation72934TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
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
REHABCARE GROUP
7733 FORSYTH BLVDST LOUISMO63105THERAPY SERVICES1256196
ROESCHEN INTERMED PHARMACY
3433 DOUGLAS AVERACINEWI53402PHARMACY SERVICES350074
VJS CONSTRUCTION
W233 N2847 ROUNDY CIRCLE WESTPEWAUKEEWI53072CONSTRUCTION125989
GREAT LAKES ROOFING CORPORATION
W194 N11095 Kleinmann DrGermantownWI53022Roofing Services115342
ADVANCED ANSWERS ON DEMAND
8100 N University DriveFt LauderdaleFL33321Software Services114770
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Fundraising Events63379FundraisingEvents
All Other Contributions103628AllOtherContributions
Total Contributions167007TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
RESIDENT SERVICE REVEN6230001855597918555979
RESIDENT ADMINISTRATIV623000614712614712
DAYCARE REVENUE623000358474358474
MISCELLANEOUS RESIDENT623000198366$198,366
BEAUTY/BARBER SHOP REV623000114861$114,861

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column209884TotalRevenueColumn
Related Or Exempt Function Income106632RelatedOrExemptFunctionIncome
Exclusion$103,252ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue20052276TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column100742TotalRevenueColumn
Exclusion$100,742ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real17069Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real17069Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column17069TotalRevenueColumn
Exclusion$17,069ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other238992Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other50751Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other188241Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column188241TotalRevenueColumn
Exclusion$188,241ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events39704GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events63379CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses39704FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Sales Of Inventory24233GrossSalesOfInventory
Cost Of Goods Sold18305CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column5928TotalRevenueColumn
Exclusion$5,928ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column20531263TotalRevenueColumn
Related Or Exempt Function Income19635797RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$728,459ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9594611Total
Program Services8063186ProgramServices
Management And General1487273ManagementAndGeneral
Fundraising44152Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total319992Total
Program Services268917ProgramServices
Management And General51075ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1510567Total
Program Services1269461ProgramServices
Management And General241106ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total667948Total
Program Services561335ProgramServices
Management And General103539ManagementAndGeneral
Fundraising3074Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total30748Total
Management And General30748ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total25929Total
Management And General25929ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1955040Total
Program Services1634606ProgramServices
Management And General320434ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2147491Total
Program Services1702595ProgramServices
Management And General444896ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1648318Total
Program Services1648318ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total26322Total
Program Services22121ProgramServices
Management And General4201ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total32963Total
Program Services27702ProgramServices
Management And General5261ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1220333Total
Program Services1220333ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total157240Total
Management And General157240ManagementAndGeneral

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
MISCELLANEOUS652856548652946109594
Bad Debt Expense133468133468

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total20123826Total
Program Services17100694ProgramServices
Management And General2966312ManagementAndGeneral
Fundraising56820Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1848424BOY
EOY4005544EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3521766BOY
EOY1155177EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1382123BOY
EOY1561855EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY57528BOY
EOY81518EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY173748BOY
EOY172465EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis26262432LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec14969512LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY11625250BOY
EOY11292920EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY2513676BOY
EOY2743068EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY449395BOY
EOY442849EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY21571910BOY
EOY21455396EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2167250BOY
EOY2307693EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY16169437BOY
EOY15529937EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY5178485BOY
EOY5173986EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY23515172BOY
EOY23011616EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-1943262BOY
EOY-1556220EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-1943262BOY
EOY-1556220EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY21571910BOY
EOY21455396EOY
FieldValueIRS element (for citing)
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

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years176415CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years205988CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years184194CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year313577CurrentTaxYearMinus1Year
Current Tax Year167007CurrentTaxYear
Total1047181Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years17002242CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years17641940CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18481049CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year18665627CurrentTaxYearMinus1Year
Current Tax Year19635797CurrentTaxYear
Total91426655Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year504040CurrentTaxYearMinus1Year
Current Tax Year480416CurrentTaxYear
Total984456Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years17178657CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years17847928CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18665243CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year19483244CurrentTaxYearMinus1Year
Current Tax Year20283220CurrentTaxYear
Total93458292Total

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 Total50993458292PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years194729CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years261886CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years260140CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year181252CurrentTaxYearMinus1Year
Current Tax Year117811CurrentTaxYear
Total1015818Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years194729CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years261886CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years260140CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year181252CurrentTaxYearMinus1Year
Current Tax Year117811CurrentTaxYear
Total1015818Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years17373386CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years18109814CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18925383CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year19664496CurrentTaxYearMinus1Year
Current Tax Year20401031CurrentTaxYear
Total94474110Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98920PublicSupportPercentage509
Prior Year Support Percentage0.98870PriorYearSupportPercentage
Investment Income Percentage0.01080InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.01130PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$2,882OtherActivitiesAmount
Total Lobbying Expenditures IIB2882TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1i:Identifier
Return ReferenceExplanation of Other Lobbying Activities:ReturnReference
ExplanationPortion of dues paid to AHCA, WHCA, and WICAL expended for lobbying purposes.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis416932OtherCostOrOtherBasis
Book Value416932BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis21288488OtherCostOrOtherBasis
Depreciation12651868Depreciation
Book Value8636620BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4148692OtherCostOrOtherBasis
Depreciation2157086Depreciation
Book Value1991606BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis408320OtherCostOrOtherBasis
Depreciation160558Depreciation
Book Value247762BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings11292920TotalOfBookValueLandBuildings

Other Securities OtherSecurities (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
BOND INTEREST FUND300534F
BOND PRINCIPAL FUND810833F
1998 DEBT SERVICE RESERVE FUND1631701F
FieldValueIRS element (for citing)
Total Of Book Value Securities2743068TotalOfBookValueSecurities

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
DEFERRED FINANCING COSTS346191
DEFERRED COMPENSATION96658
FieldValueIRS element (for citing)
Total Book Value Other Assets442849TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
DEFERRED REVENUE FROM ADVANCE FEES$3,869,388
ADDITIONAL PENSION LIABILITY$1,207,940
DEFERRED COMPENSATION$96,658
FieldValueIRS element (for citing)
Total Of Amounts5173986TotalOfAmounts
Total Revenue20531263TotalRevenue
Total Expenses20123826TotalExpenses
Excess Or Deficit For Year407437ExcessOrDeficitForYear
Net Unrealized GL On Investments-13597NetUnrealizedGLOnInvestments
Other-$6,798OtherAmount
Total Adjustments-20395TotalAdjustments
Excess Or Deficit Per FS387042ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt20539591TotRevenueEtcAuditedFinclStmt
Other Revenues-9977OtherRevenues
Revenue Not Rptd F990-9977RevenueNotRptdF990
Revenue Subtotal20549568RevenueSubtotal
Other Revenues Not Included-18305OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-18305RevenueNotRptdOnFinStmt
Total Revenue Per Form99020531263TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt20132154TotExpensesEtcAuditedFinclStmt
Other Expenses Included18305OtherExpensesIncluded
Expenses Not Rptd F99018305ExpensesNotRptdF990
Expenses Subtotal20113849ExpensesSubtotal
Other Expenses Not Included9977OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt9977ExpensesNotRptdOnFinStmt
Total Expenses Per Form99020123826TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part X:Description of Uncertain Tax Positions Under FIN 48:THE CORPORATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS.
Part XI, Line 8 - Other Adjustments:EXCESS UNFUNDED PENSION OBLIGATION: -6798.
Part XII, Line 2d - Other Adjustments:Fees from sale of land: -9977.
Part XII, Line 4b - Other Adjustments:INVENTORY COST OF GOODS SOLD: -18305.
Part XIII, Line 2d - Other Adjustments:INVENTORY COST OF GOODS SOLD: 18305.
Part XIII, Line 4b - Other Adjustments:fees from sale of land: 9977.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Golf OutingNameOfEvent1
Gross Receipts Event184470GrossReceiptsEvent1
Charitable Contributions Event144766CharitableContributionsEvent1
Gross Revenue Event139704GrossRevenueEvent1
Other Direct Expenses Event139704OtherDirectExpensesEvent1
Name Of Event2Holiday BazaarNameOfEvent2
Gross Receipts Event217399GrossReceiptsEvent2
Charitable Contributions Event217399CharitableContributionsEvent2
Gross Receipts Total101869GrossReceiptsTotal
Charitable Contributions Total62165CharitableContributionsTotal
Gross Revenue Total Events39704GrossRevenueTotalEvents
Other Direct Expenses Total Events39704OtherDirectExpensesTotalEvents
Direct Expense Summary Events39704DirectExpenseSummaryEvents
Net Income Summary0NetIncomeSummary

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
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 (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
RICHARD RAU
198651025894033909036660217200283840000
DENNIS FERGER
148195015364017799015470243600207265000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 7aThe 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 7bThe 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 11Once 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 12cClement 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 15The 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 19The organization will make their governing documents, conflict of interest policy, and financial statements available upon request.
Form 990, Part XI, Line 2cThe 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.Oversight of Audit

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 NADirectControllingEntityNA
School Sisters of St Francis
1501 S Layton BlvdMilwaukeeWI53215391594407Religious OderWI501(c)(3)1N/A
Maryhill Manor
501 Madison AvenueNiagaraWI54151391501353Nursing HomeWI501(c)(3)9N/A
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 Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org1SaleOfAssetsToOtherOrg
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 Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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