2011-08-12T08:27:39-05:00 2010-12-31 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2010-01-01 390806344 FOND DU LAC LUTHERAN HOME INC FOND 9209219520 244 N MACY STREET FOND DU LAC WI 549353393 GARY WAGNER 9209219520 2011-08-09 1 KIMBERLY HELLER CPA 7158453111 2011-08-09 2010 2016-02-24 21:20:13Z GARY WAGNER 244 N MACY STREET FOND DU LAC WI 549353393 9449037 0 X WWW.LUTHERANHOMESFONDDULAC.ORG X 1939 WI FOND DU LAC LUTHERAN HOME, AS PART OF LHHS, PROVIDES A CHRISTIAN-BASED INNOVATIVE APPROACH TO AGING THROUGH COMPREHENSIVE SERVICES, PROGRAMS AND COMMUNITIES. 3 3 282 0 0 0 0 0 9817268 9399686 6347 9017 35829 39204 9859444 9447907 0 0 0 0 6662777 6615889 0 0 0 3005142 2949631 9667919 9565520 191525 -117613 5917310 5733303 2326016 2256032 3591294 3477271 X FOND DU LAC LUTHERAN HOME, AS PART OF LHHS, PROVIDES A CHRISTIAN-BASED INNOVATIVE APPROACH TO AGING THROUGH COMPREHENSIVE SERVICES, PROGRAMS AND COMMUNITIES. 0 0 8242206 9367679 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., AN 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 30,776 MEDICAID DAYS, 4,561 MEDICARE DAYS AND 44,263 TOTAL NURSING HOME DAYS IN 2010.ASSISTED LIVING:THE FOND DU LAC LUTHERAN HOME'S ASSISTED LIVING PROGRAM 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 10,908 BED DAYS IN 2010. 8242206 1 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 15 0 1 282 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 31613 94838 23049 GARY WAGNER 30.00 X 58728 19576 4099 90341 114414 27148 0 0 0 0 HUMANA INSURANCE CO PO BOX 533 CAROL STREAM IL 60132 HEALTH INSURANCE 799149 WI DEPT OF HEALTH AND FAMILY SERVICES PO BOX 93594 MILWAUKEE WI 53293 BED TAX 255360 REINHART FOOD SERVICE LLC 2655 RICHMOND STREET SHAWANO WI 54166 FOOD SERVICES 239019 ALLIANCE PHARMACY SERVICES 407 PILOT CT WAUKESHA WI 53188 PHARMACY 175792 BAND BOX PO BOX 299 TOMAH WI 54660 LAUNDRY SERVICES 138671 5 NURSING HOME 623000 5091709 5091709 NURSING HOME PRIVATE P 623000 3253711 3253711 RESIDENTIAL FACILITY 623000 1022259 1022259 MISC REVENUE 900000 32007 32007 9399686 10059 10059 1042 -1042 -1042 -1042 39292 88 39204 39204 9447907 9367679 0 80228 231903 231903 5128173 4972219 155954 98684 91543 7141 777234 720993 56241 379895 350657 29238 60000 60000 14327 14327 29298 29298 3219 3219 33287 22099 11188 7131 5545 1586 80812 80812 421256 421256 65376 65376 SUPPLIES 752445 732744 19701 CONTRACTED SERVICES 602461 374378 228083 UTILITIES 274473 260131 14342 WMAP BED ASSESSMENT 255360 255360 MISCELLANEOUS 140420 76473 63947 209766 133356 76410 9565520 8242206 1323314 0 561738 881853 378497 843330 869617 8186 8098 45546 52718 11980594 8658360 3456285 3322234 623728 598783 5917310 5733303 502144 635039 844656 739072 979216 881921 2326016 2256032 X 3495716 3378103 95578 99168 3591294 3477271 5917310 5733303 X -117613 3590 X X 0 1 1 X 0 X 8680528 8566310 9798662 9817268 9367679 46230447 37144 39382 71299 147825 8680528 8566310 9835806 9856650 9438978 46378272 0 0 0 46378272 12565 6791 6182 9017 10059 44614 12565 6791 6182 9017 10059 44614 8693093 8573101 9841988 9865667 9449037 46422886 0.99900 0.99420 0.00100 0.10000 X 60413 60413 8451718 5828858 2622860 3348731 2758346 590385 119732 71156 48576 3322234 INTEREST IN NET ASSETS OF FOUNDATION 99168 DEFERRED CHARGES, NET 20596 UNEMPLOYMENT COMP DEPOSIT 177631 DUE FROM LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION, INC. 124911 DUE FROM LUTHERAN HOMES AND HEALTH SERVICES, INC. 143534 DUE FROM ST. PETERS 18943 INVESTMENT IN DENEVEU CREEK LLC 14000 598783 9447907 9565520 -117613 3590 3590 -114023 9447907 0 9447907 0 9447907 9565520 0 9565520 0 9565520 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: LUTHERAN HOME IS A TAX-EXEMPT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. LUTHERAN HOME IS ALSO EXEMPT FROM STATE INCOME TAX ON RELATED INCOME. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740, 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 OR 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 UNRECOGNIZED TAX BENEFITS. LUTHERAN HOME'S FEDERAL RETURNS FOR TAX YEARS 2007 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI - CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION = 3,590 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 & 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 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 LHHS BOARD MEMBER, THE BOARD THEN DISCUSSES PERFORMANCE IN EXECUTIVE SESSION AND THE EXECUTIVE COMMITTEE RECOMMENDS COMPENSATION BASED ON CURRRENT COMPARABILITY DATA (MULTIPLE SOURCES)AND THEN THE BOARD VOTES. THE CEO DOES AN ANNUAL WRITTEN EVALUATION AND THE AMOUNT OF COMPENSATION IS BASED ON THE CURRENT AREA COMPARABILITY DATA. 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 3,590. TOTAL TO FORM 990, PART XI, LINE 5: 3,590. 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 10 HOURS PER WEEK AS FOLLOWS: LUTHERAN HOMES AND HEALTH SERVICES, INC. 10 HOURS. LUTHERAN HOME 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 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0