2022-04-06T17:17:14-05:00 2021-06-30 410746749 CLIFTONLARSONALLEN LLP 10401 W INNOVATION DR STE 300 WAUWATOSA WI 53226 990 2020-07-01 391020547 CLEMENT MANOR INC CLEM 4143211800 3939 S 92ND STREET GREENFIELD WI 53228 DENNIS FERGER PRESIDENT/CEO 4143211800 2022-04-05 1 DENNIS FERGER 999009999 KRISTEN DONLEVY P01670215 4144761880 2022-04-05 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z DENNIS FERGER 3939 S 92ND STREET GREENFIELD WI 53228 17175304 0 X WWW.CLEMENTMANOR.COM X 1963 WI CLEMENT 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 COMMUNITIEIS THROUGH THE VALUES 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 THEIR 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, ALWYS KEEPING THE FACILITY AT THE FOREFRONT OF IMPORVEMENTS IN THE LONG TERM CARE INDUSTRY TO ENSURE THE BEST CARE POSSIBLE. CLEMENT MANOR IS ALSO AN ASSOCIATE MEMBER OF THE BENEDICTINEHEALTH SYSTEM, A CATHOLIC HEALTH CARE ORGANIZATION WELL-KNOWN AND RESPECTED IN THE PROFESSION. 13 13 366 38 0 0 554714 3294508 15255887 13857642 53048 1579 -165426 21175 15698223 17174904 0 0 0 0 9338440 9254619 0 0 23973 7329233 7030729 16667673 16285348 -969450 889556 21207841 20515190 24852934 23270727 -3645093 -2755537 X CLEMENT 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. 0 0 11932200 13460779 CLEMENT MANOR, INC. OPERATES A SKILLED NURSING FACILITY, A CONTINUING CARE FACILITY WHICH INCLUDES A RESIDENTIAL CARE APARTMENT COMPLEX, AND AN ADULT 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 2021 WAS APPROXIMATELY $2,705,000. IN ADDITION, CLEMENT PROVIDED APPROXIMATELY $24,000 OF CHARITY CARE SERVICES TO THE NEEDY IN FISCAL 2021. 11932200 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 18 0 1 366 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 13 13 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X KWASI OFORI-TANO 4143211800 3939 SOUTH 92ND STREET GREENFIELD WI 53228 DENNIS FERGER PRESIDENT/CEO 40.00 X X 242580 0 9626 AMY KESLER VICE CHAIR (THRU 9/20) 0.30 X 0 0 0 SISTER JUDEEN SCHULTE BOARD SECRETARY 0.30 X X 0 0 0 PHILIP DOUGHERTY JR BOARD CHAIR 0.30 X X 0 0 0 KRISTA PANKOP BOARD TREASURER 0.30 X X 0 0 0 ANN MAHER VICE CHAIR 0.30 X X 0 0 0 KEVIN NITKA BOARD MEMBER (THRU 11/20) 0.30 X 0 0 0 WENDY PROVOST BOARD MEMBER 0.30 X 0 0 0 SISTER CAROL GRANDLICH BOARD MEMBER (THRU 10/20) 0.30 X 0 0 0 ALISSA KARL BOARD MEMBER 0.30 X 0 0 0 SISTER ELIZABETH SCHMITZ BOARD MEMBER 0.30 X 0 0 0 SUSAN SAJDAK BOARD MEMBER 0.30 X 0 0 0 MEGHAN FROEHLICH BOARD MEMBER 0.30 X 0 0 0 JAMES SAJDAK BOARD MEMBER 0.30 X 0 0 0 JOHN HEINDEL BOARD MEMBER 0.30 X 0 0 0 CATHLEEN KELLING BOARD MEMBER 0.30 X 0 0 0 DIANE LEPKOWSKI CFO 40.00 X 123346 0 5704 ROBERTA BANACH DIRECTOR OF NURSING 40.00 X 118102 0 9483 484028 0 24813 3 0 1 0 SELECT REHABILITATION LLC PO BOX 71985 CHICAGO IL 60694 THERAPY SERVICES 783843 ROESCHEN INTERMED PHARMACY 3433 DOUGLAS AVE RACINE WI 53402 PHARMACY SERVICES 241764 ADVANCE CATASTROPHE TECHNOLOGIES INC 3835 N HILLCREST STE 4 BEL AIRE KS 67220 SANITATION, RECOVERY AND RESTORATION 188980 VJS CONSTRUCTION SERVICES W233 N2487 ROUNDY CIRCLE WEST PEWAUKEE WI 53072 CONSTRUCTION SERVICES 154667 ARAMARK UNIFORM SERVICES 25259 NETWORK PLACE CHICAGO IL 60673 LAUNDRY SERVICES 147797 6 41445 3165737 87326 3294508 RESIDENT SERVICE REVENUE 623000 12441737 12441737 RESIDENT ADMINISTRATIVE SERVICE R 623000 999956 999956 RESIDENT FEES 623000 250348 19086 231262 MISCELLANEOUS RESIDENT SERVICES 623000 136947 136947 BEAUTY/BARBER SHOP REVENUE 623000 28654 28654 13857642 1579 1579 21575 41445 400 21175 21175 17174904 13460779 0 419617 X 365926 182963 182963 6956730 5246113 1710617 186989 141010 45979 1222881 901495 321386 522093 386880 135213 17751 17751 17375 17375 1815599 1095072 720527 1322902 516046 806856 569245 569245 2392 1761 631 32748 24090 8658 771340 771340 1533137 1533137 212089 212089 LEASES 421852 421852 MISCELLANEOUS 232791 59688 149130 23973 BAD DEBT EXPENSE 81508 81508 16285348 11932200 4329175 23973 5630615 5553189 741053 809280 134997 152515 42202 46236 42025219 31050379 10810725 10974840 3848249 2979130 21207841 20515190 3485472 2512196 15934977 15946762 92880 92880 270893 178013 5068712 4540876 24852934 23270727 X -3645093 -2755537 -3645093 -2755537 21207841 20515190 889556 0 X 0 1 X 1 0 X 148424 102945 203895 554714 3294508 4304486 18674412 17585442 15565348 14857502 13672955 80355659 478073 691655 406552 425614 205862 2207756 19300909 18380042 16175795 15837830 17173325 86867901 0 0 0 86867901 14848 15410 11700 61808 1579 105345 14848 15410 11700 61808 1579 105345 19315757 18395452 16187495 15899638 17174904 86973246 0.99880 0.99870 0.00120 0.00130 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 926 926 0 PART II-B, LINE 1: PORTION OF DUES PAID TO AHCA, WICAL, AND WHCA EXPENDED FOR LOBBYING PURPOSES. 416932 416932 32125822 23808921 8316901 9144169 6995863 2148306 338296 245595 92701 10974840 BOND ESCROW FUNDS 2979130 2979130 DEFERRED REVENUE FROM ADVANCE FEES 4540876 4540876 X 17174904 0 17174904 0 17174904 16285348 0 16285348 0 16285348 PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, INCOME TAXES, REQUIRES A CORPORATION TO ASSESS 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 THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE CORPORATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS AT JUNE 30, 2021 AND 2020. GOLF OUTING 63020 41445 21575 400 63020 41445 21575 400 400 21175 X X 0 0 0 0 0 0 0 0 0 DENNIS FERGER PRESIDENT/CEO 207295 0 35285 0 0 0 1607 0 8019 0 252206 0 0 0 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DW40 2019-07-31 16514438 SEE PART VI 0 1 0 A 16514440 1059075 330289 3472381 10660227 992467 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 0 SCHEDULE K, PART I, BOND ISSUES: (F) DESCRIPTION OF PURPOSE: THE FUNDS WERE USED TO REFUND THE DEBT OBLIGATIONS WITH TCF BANK (SERIES 2013A TAX-EXEMPT BONDS, CONSTRUCTION TERM LOAN AND LINE OF CREDIT) AND TO PAY FOR CONSTRUCTION OF A NEW BUILDING WING AND CAPITAL IMPROVEMENTS AS THEY COME UP. FORM 990, PART VI, SECTION A, LINE 2 SUSAN SAJDAK AND JAMES SAJDAK HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION IS A SPONSORED MINISTRY OF THE SCHOOL SISTERS OF ST FRANCIS OF ST JOSEPH'S CONVENT, MILWAUKEE, WISCONSIN, INC US PROVINCE (SSSF U.S. PROVINCE). THE ELECTED LEADERS OF THE SSSF U.S. PROVINCE AND ITS TREASURER SERVE AS CORPORATE MEMBERS AND EXERCISE CONTROL OF THIS SUBSIDIARY CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE 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 7B THE 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 INCORPORATION AND THE BYLAWS OF THE CORPORATION. TO APPROVE THE BYLAWS OF ALL ORGANIZATIONS UNDER THE AUSPICES OF THE CORPORATION. TO APPOINT AND TERMINATE THE CEO OF THE CORPORATION, AS RECOMMENDED BY THE BOARD OF DIRECTORS. 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 APPROVE 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. FORM 990, PART VI, SECTION B, LINE 11B ONCE CLEMENT MANOR RECEIVES THE COMPLETED FORM 990, THEY SEND A COPY TO THE EXECUTIVE COMMITTEE OF THEIR BOARD OF DIRECTORS. IT IS THEN DISCUSSED AND APPROVED AT A BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C CLEMENT MANOR HAS ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES SIGN THE CONFLICT OF INTEREST STATEMENTS ANNUALLY, DISCLOSING ALL CONFLICTS OF INTEREST. CONFLICT OF INTEREST POLICY: DIRECTORS, OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS SHALL NOT DIVULGE OR COMMUNICATE TO ANY PERSON(S) ANY CONFIDENTIAL INFORMATION OF ANY KIND CONCERNING ANY MATTERS AFFECTING OR RELATING TO THE BUSINESS OF CLEMENT MANOR AND ITS PARTICIPATING ORGANIZATIONS. IF ONE IS NOT SURE IF INFORMATION IS CONFIDENTIAL, SUCH PERSON SHOULD REQUEST A DETERMINATION BY THE BOARD, THE CHAIRPERSON OF THE BOARD OR THE PRESIDENT, CEO OR ADMINISTRATOR. TRANSACTIONS INVOLVING CONFLICTS OF INTEREST INCLUDE BUT ARE NOT LIMITED TO: 1. THE SALE, PURCHASE, LEASE OR RENTAL OF ANY PROPERTY OR OTHER ASSET, 2. EMPLOYMENT OR RENDITION OF SERVICES, PERSONAL OR OTHERWISE, 3. THE AWARD OF ANY GRANT, CONTRACT, OR SUBCONTRACT, OR 4. THE INVESTMENT OR DEPOSIT OF ANY FUNDS OF THE CORPORATION. THIS PROHIBITION SHALL NOT, HOWEVER, PREVENT THE DISCLOSURE OF CONFIDENTIAL INFORMATION TO AN OFFICER OR DIRECTOR OR AN ORGANIZATION THAT CONTROLS CLEMENT MANOR. CONFLICT OF INTEREST PROCEDURES: 1. EVERY DIRECTOR, OFFICER, AND EMPLOYEE IS FAMILIARIZED WITH THE CONFIDENTIALITY POLICY DURING THEIR ORIENTATION PERIOD OR PRIOR TO ASSUMING THEIR DUTIES OR TERMS OF OFFICE, 2. WHENEVER A DIRECTOR, OFFICER, OR EMPLOYEE FEELS THAT A CONFLICT OF INTEREST SITUATION IS OR MAY BE INVOLVED, THE FACTS ARE TO BE PROMPTLY DISCLOSED A) IN THE CASE OF AN EMPLOYEE THE FACTS SHOULD BE KNOWN TO THE CHIEF EXECUTIVE OFFICER, B) IN THE CASE OF A DIRECTOR THE FACTS SHOULD BE KNOWN TO THE PRESIDENT OF THE BOARD OF DIRECTORS. THEREAFTER THE DIRECTOR SHALL REFRAIN FROM DISCUSSING OR VOTING ON THE PARTICULAR TRANSACTION IN WHICH HE HAS AN INTEREST OR OTHERWISE ATTEMPTING TO EXERT ANY INFLUENCE ON THE CORPORATION, ITS BOARD OF DIRECTORS, OR ITS COMMITTEES, TO AFFECT ITS DECISION TO PARTICIPATE IN SUCH TRANSACTION. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE, AND THE ABSTENTION FROM DISCUSSION AND VOTING ON THE PARTICULAR TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE CEO, CFO AND OTHER KEY MANAGEMENT STAFF REVIEW 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 LEADING AGE PUTS TOGETHER. CLEMENT MANOR'S GOAL IS TO REMAIN AROUND THE 75TH PERCENTILE OF THE SURVEY. IF THEY ARE BELOW, THE CEO, CFO, AND OTHER KEY MANAGEMENT STAFF DECIDE 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 19 THE ORGANIZATION WILL MAKE THEIR GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G NURSING SERVICES: PROGRAM SERVICE EXPENSES 281,464. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 281,464. THERAPY SERVICES: PROGRAM SERVICE EXPENSES 424,822. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 424,822. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 18,854. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,854. RELIGIOUS SERVICES: PROGRAM SERVICE EXPENSES 3,107. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,107. CLEANING/LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 87,430. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 87,430. MAINTENANCE: PROGRAM SERVICE EXPENSES 279,395. MANAGEMENT AND GENERAL EXPENSES 630,514. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 909,909. CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 39,394. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,394. DATA PROCESSING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 50,619. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,619. THE SCHOOL SISTERS OF ST FRANCIS OF ST JOSEPH'S CONVENT 1515 S LAYTON BLVD MILWAUKEE WI 53215 390806266 RELIGIOUS ORDER WI 501(C)(3) LINE 1 N/A 0 MARYHILL MANOR 501 MADISON AVENUE NIAGARA WI 54151 391501353 NURSING HOME WI 501(C)(3) LINE 10 US PROVINCE OF THE SCHOOL SISTERS OF ST FRANCIS 0 OUR LADY OF THE ANGELS 3995 S 92ND STREET GREENFIELD WI 53228 271566571 RELIGIOUS ORDER WI 501(C)(3) LINE 1 US PROVINCE OF THE SCHOOL SISTERS OF ST FRANCIS AND CENTRAL PACIFIC PROV 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 THE SCHOOL SISTERS OF ST FRANCIS OF ST JOSEPH'S CONVENT M 79000 ACTUAL COST THE SCHOOL SISTERS OF ST FRANCIS OF ST JOSEPH'S CONVENT Q 340000 ACTUAL COST