2011-02-01T15:53:59-06:00 2010-09-30 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2009-10-01 390829541 SHADY LANE INC SHAD 9206828254 1235 SOUTH 24TH STREET MANITOWOC WI 542205516 Gregg Chaloupka 9206828254 2011-01-28 1 Terri Rexrode CPA MST 9206620016 2011-01-28 2009 2016-02-24 21:20:13Z Gregg Chaloupka 1235 South 24th Street Manitowoc WI 54220 11785854 0 X www.shadylaneinc.com X 1950 WI NURSING CARE FOR the AGED AND DISABLED. 14 14 342 19 0 0 3130 1496 11555687 11565794 292328 218564 0 11851145 11785854 0 0 6712434 6883292 0 0 4114315 4253628 10826749 11136920 1024396 648934 19180227 19751474 7210851 7046715 11969376 12704759 Shady Lane strives to provide older adults in Manitowoc County the highest quality residential care at a reasonable cost. Residents of Shady Lane can expect to enjoy a home-like setting with a supportive atmosphere that respects individuality, promotes physical and emotional well being, and encourages independence. 0 0 9081933 9886359 Skilled Nursing services are offered to the senior population. These are the higher acuity population needing the most intense skilled nursing services. residents treated can include the private pay residents, and the residents on government funding (Medicare and Medicaid). Number of residents treated in plan year were 320. 1044346 1492324 Assisted living services are offered to the lighter care assisted living population. These residents can maintain an amount of independence while still receiving the necessary nursing service to maintain a quality of life. Residents in the assisted living can include the private pay residents and residents receiving government funding. Number of residents treated in plan year were 87. 10126279 1 0 0 0 0 0 0 0 1 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 0 0 0 0 1 6 0 1 342 1 0 0 0 0 0 0 0 0 0 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X GREGG CHALOUPKA 9206828254 1235 S 24TH STREET Manitowoc WI 54220 DON KARMAN 0.50 X 0 0 0 Deb Gabriel 0.50 X 0 0 0 JANE FOSTER 0.50 X 0 0 0 Melanie Tiedt 0.50 X 0 0 0 CARL LAVECK 0.50 X 0 0 0 PATTY Lou POHLMANN 0.50 X 0 0 0 JOHN TORKE 0.50 X 0 0 0 JIM FUHS 0.50 X 0 0 0 Scott McMeans 0.50 X 0 0 0 Tom Mueller 0.50 X 0 0 0 Jim Noffke 0.50 X 0 0 0 Dr Joseph DiRaimondo 0.50 X 0 0 0 Katherine Reynolds 0.50 X 0 0 0 Ron Schwalbe 0.50 X 0 0 0 TODD MEERDINK 40.00 X 155667 0 16848 GREGG CHALOUPKA 40.00 X 103479 0 5705 259146 0 22553 2 0 1 0 REHAB CARE GROUP INC PO BOX 503534 ST LOUIS MO 631503534 THERAPY SERVICES 613611 1 1496 1496 Skilled Nursing Facili 623000 9886359 9886359 Assisted Living Facili 623000 1492324 1492324 Cafeteria Revenues 623000 129991 129991 Other 623000 39396 39396 Beauty & Barber Shop 623000 17724 17724 11565794 218564 218564 11785854 11378683 0 405675 5911616 5340009 571607 78007 70464 7543 389383 351733 37650 504286 455525 48761 6855 6855 27207 27207 744548 706236 38312 73634 73634 1497989 1411204 86785 330333 310656 19677 2946 2718 228 269909 253831 16078 662005 622571 39434 254089 235903 18186 BED ASSESSMENT 321780 321780 Other 36676 17992 18684 Bad Debt Expense 25657 25657 11136920 10126279 1010641 0 642 589 1330025 378390 1004267 1115880 40570 40570 116488 111826 14573365 6703886 7982642 7869479 1636227 1799691 6920862 8301435 148504 133614 19180227 19751474 776623 910165 6100000 5800000 334228 336550 7210851 7046715 X 11944376 12679759 25000 25000 11969376 12704759 19180227 19751474 X 0 1 1 X 0 X 33345 3130 1496 37971 11434345 10434890 10898636 11404858 11378683 55551412 141791 147135 150829 187111 626866 11434345 10576681 11079116 11558817 11567290 56216249 0 0 0 56216249 267361 364274 384358 292373 218564 1526930 267361 364274 384358 292373 218564 1526930 11701706 10940955 11463474 11851190 11785854 57743179 0.97360 0.97450 0.02640 0.02550 X 25000 287 287 25000 25000 37 37 25000 0 0 216216 216216 11363251 5223493 6139758 2993898 1480393 1513505 7869479 INVESTMENTS - OTHER 110000 F CERTIFICATES OF DEPOSIT 8166435 F PERM RESTRICTED FUNDS 25000 F 8301435 INTEREST RATE SWAP 336550 336550 11785854 11136920 648934 88771 -2322 86449 735383 11785854 0 11785854 0 11785854 11136920 0 11136920 0 11136920 Part X: Description of Uncertain Tax Positions Under FIN 48: In order to account for any uncertain tax positions, ASC Topic 740-10, Accounting for Uncertainty in Income Taxes, requires an organization to determine 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 that position is not recognized in the financial statements. Part XI, Line 8 - Other Adjustments: INTEREST RATE SWAP AGREEMENT ADJUSTMENT: -2322. X X X 0 0 0 0 0 0 0 0 0 TODD MEERDINK 145667 0 10000 0 0 0 5025 0 11823 0 172515 0 0 0 Form 990, Part VI, Section B, line 11 The Form 990 is provided to the organizations' Board of Directors executive committee before it was filed. The executive committee designates the detail review of the Form 990 to management, but has final approval of the return. Form 990, Part VI, Section B, line 12c The board of directors authorizes the Officers of the Organization to periodically, but not less than annually, survey the board members regarding any potential conflicts, to maintain such information and report back to the Board regarding any potential conflicts of interest. Form 990, Part VI, Section B, line 15 The process for determining compensation for the officers and other key employees of the organization include: 1) review and approval by the Executive Committee of the Board of Directors (those without conflict); 2) use of data as to comparable compensation; and 3) contemporaneous documentation and record keeping. Form 990, Part VI, Section C, line 19 The organization believes its governing documents, conflict of interest policy, and financial statements are the property of the organization and does make available to the public. Form 990, Part XI, Line 2c: The Finance Committee is responsible for the oversight of the audit and selection of the audit firm. This process has not changed from the prior year.