2022-11-15T15:52:13-06:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2021-01-01 390981434 UNITED LUTHERAN PROGRAM FOR THE AGING INC UNIT 4144643880 4545 NORTH 92ND STREET WAUWATOSA WI 53225 ARTHUR KEUP CFO 4144646396 2022-11-10 1 ARTHUR KEUP 999009999 KIMBERLY ANDERSON P00188889 6086628600 2022-11-10 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z LUTHER MANOR STEPHANIE CHEDID 4545 NORTH 92ND STREET WAUWATOSA WI 53225 34139465 0 X WWW.LUTHERMANOR.ORG X 1957 WI TO SHARE GOD'S LOVE BY ENRICHING THE LIVES OF OLDER ADULTS BY LEADING THE WAY IN ABUNDANT LIVING FOR ALL WHO TRUST US TO CARE. 9 8 571 88 0 0 5589397 8371979 23970054 22936893 621562 670437 288557 559245 30469570 32538554 0 0 0 0 16999205 16695939 0 0 28389 13222021 12282991 30221226 28978930 248344 3559624 46394633 44109199 25131980 19364525 21262653 24744674 X TO SHARE GOD'S LOVE BY ENRICHING THE LIVES OF OLDER ADULTS AND BY LEADING THE WAY IN ABUNDANT LIVING FOR ALL WHO TRUST US TO CARE. 0 0 10138066 11927184 LUTHER MANOR HEALTH CARE CENTER PROVIDES SKILLED NURSING CARE AND SERVICES FOR FRAIL ELDERLY. WITHIN THE HEALTH CARE CENTER IS A DEDICATED REHABILITATION CENTER. THE HEALTH CARE CENTER ALSO HAS A CONTRACT WITH A HOSPITAL SYSTEM TO ASSIST IN TRANSITIONING DIFFICULT TO PLACE PATIENTS TO THEIR MOST IDEAL CARE SETTING. THIS PROGRAM, OUR ALTERNATIVE TRANSITIONAL CARE PROGRAM, FILLS A DIRE SERVICE GAP IN THE PUBLIC HEALTHCARE & SUPPORT SYSTEM AND ENABLES THE HOSPITAL SYSTEM TO PROVIDE CARE TO THOSE WITH THE GREATEST NEED. THE FACILITY IS LICENSED FOR PARTICIPATION IN BOTH MEDICARE AND MEDICAID. 3899256 4587379 THE LUTHER MANOR TERRACE (LMT) PROVIDES ENGAGING AND SUPPORTIVE INDEPENDENT LIVING HOUSING AND SERVICES FOR OLDER ADULTS. APARTMENT RESIDENTS OFTEN CHOOSE THE LMT IN ORDER TO BECOME PART OF A LIFE PLAN COMMUNITY SETTING. THE LMT SERVICES AND AMENITIES INCLUDE LIFE ENRICHMENT OPPORTUNITIES, TRANSPORTATION SERVICES, DINING PROGRAM, SPIRITUAL WELLNESS, FITNESS, HEALTH, ENTERTAINMENT AND CULTURAL PROGRAMS. THE LMT ALSO PROVIDES PERSONAL CARE SERVICES TO RESIDENTS THROUGH THE SUPPORTIVE LIVING "RESIDENTIAL CARE APARTMENT COMPLEX" RCAC PROGRAM, WHICH HELPS RESIDENTS MAINTAIN INDEPENDENT LIVING. 3509330 4128641 THE COURTYARDS AT LUTHER MANOR PROVIDES SUPPORTIVE (ASSISTED) LIVING SERVICES FOR FRAIL ELDERLY WHO RESIDE IN LUTHER MANOR'S LICENSED "COMMUNITY BASED RESIDENTIAL FACILITY (CBRF)". THE COURTYARDS PROGRAM ALSO INCLUDES "SPECIAL CARE" SERVICES FOR PERSONS WITH ALZHEIMER'S DISEASE AND OTHER FORMS OF DEMENTIA. THE COURTYARDS IS MEDICAID-CERTIFIED, ACCEPTING MEDICAID-WAIVER PROGRAM FUNDING. 1949628 2293689 LUTHER MANOR AT RIVER OAKS IS A 16-UNIT ASSISTED LIVING CENTER LOCATED IN MEQUON, WI. RIVER OAKS OFFERS SUPPORTIVE, ASSISTED LIVING AND 24-HOUR CARE SERVICES IN A WARM, HOME-LIKE SETTING. UNIQUE TO RIVER OAKS IS THE ABILITY TO FORM RELATIONSHIPS WITH STAFF WHICH ISN'T ALWAYS POSSIBLE IN A LARGER SETTING. LUTHER MANOR HOSPICE PROVIDES PATIENTS AND THEIR LOVED ONES THE OPPORTUNITY TO MAKE DECISIONS ABOUT END-OF-LIFE CARE, WHILE BEING SUPPORTED BY A DEDICATED, COMPASSIONATE STAFF OF PHYSICIANS, NURSES, CHAPLAINS, SOCIAL WORKERS AND COUNSELORS. HOSPICE IS NOT A PLACE, NOR IS IT A RESIGNATION OF HOPE. IT IS NOT INTENTED TO HASTEN OR POSTPONE DEATH, BUT TO ENCOURAGE QUALITY IN LIFE, PRESERVE DIGNITY IN DYING AND OFFER SUPPORT IN GRIEF. 1949628 2293689 19496280 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 53 0 1 571 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X ARTHUR KEUP CFO 4144643880 4545 NORTH 92ND STREET WAUWATOSA WI 53225 RAYMOND ZASTROW DIRECTOR 0.50 X 0 0 0 STEPHANIE CHEDID PRESIDENT & CEO 45.00 5.00 X X 306162 0 83479 KRISTINE IWINSKI VICE CHAIR & TREASURER 1.00 X X 0 0 0 ANDREW VEDDER SECRETARY 1.00 X X 0 0 0 ELIZABETH STRACHOTA-BENZ DIRECTOR 0.50 X 0 0 0 KEITH FRALEIGH CHAIR 1.00 X X 0 0 0 DAVID EDQUIST DIRECTOR 0.50 X 0 0 0 CAROLYN ESSWEIN DIRECTOR 0.50 X 0 0 0 TRISHYA BROWN DIRECTOR 0.50 X 0 0 0 ARTHUR KEUP CFO 45.00 5.00 X 159651 0 10634 PATRICK HANSEN CHIEF EXPERIENCE OFFICER 50.00 X 176578 0 4375 HERMINIA DEGUZMAN NURSE 55.00 X 141592 0 12645 PETER KWASNIAK NURSE 47.00 X 153691 0 2307 NILDA CINTRON-CORTEZ CHIEF HR OFFICER 50.00 X 134148 0 21336 SABRINA BROOKS REGISTERED NURSE SUPERVISOR 55.00 X 122852 0 13301 CASSANDRA MCAFFEE-HALE DIRECTOR OF NURSING (DON) 46.00 X 114168 0 957 1308842 0 149034 12 0 1 0 SODEXO INC AND AFFILIATES PO BOX 360170 PITTSBURG PA 15251 DINING SERVICES 1532090 SYMBRIA REHAB INC 28100 TORCH PARKWAY SUITE 600 WARRENVILLE IL 60555 THERAPY SERVICES 1023335 CASPIAN TECHNOLOGY PO BOC 147 PEWAUKEE WI 53005 IT SERVICES 555584 JOHNSON CONTROLS PO BOX 730068 DALLAS TX 75373 HVAC SERVICES 449885 FAVORITE HEALTHCARE STAFFING INC PO BOX 26225 OVERLAND PARK KS 66225 TEMPORARY STAFFING 351258 17 3110000 5137279 124700 8371979 RESIDENT SERVICES 623000 22506614 22506614 FOUNDERS FEES 623990 430279 430279 22936893 424034 424034 1847314 1600911 246403 246403 246403 MANOR MART & SHOPPES 900099 41603 41603 HOUSEKEEPING 900099 25051 25051 CAFETERIA INCOME 900099 3732 3732 488859 488859 559245 32538554 22936893 0 1229682 559926 559926 13948773 10058795 3889978 58108 38170 19938 1173352 960073 213279 955780 711714 244066 82239 82239 44115 44115 59898 59898 498172 173417 324755 332031 63720 241722 26589 44371 6881 37490 480482 147267 333215 1353528 1277122 76406 9769 8241 1448 80 11612 5544 6068 310411 310411 2519635 2392287 127348 373430 373430 ALL OTHER EXPENSES 3146036 73935 3070381 1720 DINING FOOD AND SUPPLIE 1491245 1491245 SUPPLIES 881212 761248 119964 PHARMACEUTICALS 331740 331740 313065 311040 2025 28978930 19496280 9454261 28389 4980976 2658668 71536 129767 2820227 3037618 96486 69756 214196 245934 96447861 78226598 18931646 18221263 19124435 19642697 155131 103496 46394633 44109199 2633056 2305093 3458500 1541251 422548 9215311 8272821 62663 76660 68803 8221199 8218600 25131980 19364525 X 21201591 24621887 61062 122787 21262653 24744674 46394633 44109199 X 3559624 -150321 72718 X 0 1 X 1 1 1 X 1348161 1327002 1485268 5589397 8371979 18121807 30302614 28957454 27070157 23970054 22963893 133264172 31650775 30284456 28555425 29559451 31335872 151385979 0 0 0 151385979 665134 706295 634289 475550 424034 2905302 665134 706295 634289 475550 424034 2905302 259586 251652 766602 288557 135995 1702392 32575495 31242403 29956316 30323558 31895901 155993673 0.97050 0.96910 0.01860 0.01970 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 336498 336498 64344889 54167079 10177810 28212583 22085660 6126923 3553891 1973859 1580032 18221263 FOUNDERS FEES 8218600 8218600 X 32399226 -150321 10993 -139328 32538554 0 32538554 28978930 0 28978930 0 28978930 PART IV, LINE 2B: RESIDENT FUNDS ARE HELD BY THE ORGANIZATION WHICH RESIDENTS CAN ACCESS IF IN NEED OF ANY AMOUNT OF MONEY IN WHICH THE RESIDENT HAS ENTRUSTED THE ORGANIZATION. THESE FUNDS ARE OFTEN USED FOR MINOR PURCHASES. THIS ASSET IS IN CORRELATION WITH A LIABILITY FOR THE SAME AMOUNT. PART X, LINE 2: THE CORPORATION FOLLOWS THE ACCOUNTING STANDARDS FOR CONTINGENCIES IN EVALUATING UNCERTAIN TAX POSITIONS. THE CORPORATION FILES INFORMATIONAL RETURNS AS A TAX-EXEMPT ORGANIZATION, WHICH ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: ASSETS RELEASED FROM RESTRICTIONS 10,993. X X X X 0 1 0 0 0 0 0 1 1 1 STEPHANIE CHEDID PRESIDENT & CEO 253162 0 53000 0 0 0 51824 0 31655 0 389641 0 0 0 PATRICK HANSEN CHIEF EXPERIENCE OFFICER 159578 0 17000 0 0 0 1824 0 2551 0 180953 0 0 0 ARTHUR KEUP CFO 142651 0 17000 0 0 0 1784 0 8850 0 170285 0 0 0 PETER KWASNIAK NURSE 153691 0 0 0 0 0 2306 0 1 0 155998 0 0 0 NILDA CINTRON-CORTEZ CHIEF HR OFFICER 126205 0 0 0 7943 0 1824 0 19512 0 155484 0 0 0 HERMINIA DEGUZMAN NURSE 141592 0 0 0 0 0 1824 0 10821 0 154237 0 0 0 PART I, LINE 4B THE CEO IS ELIGIBLE FOR A 457(F) DEFERRED COMPENSATION ARRANGEMENT UNDER THE EMPLOYMENT AGREEMENT. UNITED LUTHERAN PROGRAM FOR THE AGING CONTRIBUTES TO THE PLAN ANNUALLY. IT IS PAID OUT UPON TERMINATION. IN 2021 THE 457(F) DEFFERRED COMPENSATION PLAN ACCRUED $30,500 TO THE CEO. PART I, LINE 7 THE CEO, CFO, CHRO, CXO AND CCO ARE ELIGIBLE FOR DISCRETIONARY BONUS PAYMENTS. PART I, LINE 8 THE ORGANIZATION HAS A DEFERRED COMPENSATION PLAN UNDER 457(B) AND 457(F) PLAN FOR CEO. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2012-08-29 21170000 REFUNDING OF 2009 BONDS AND FUNDING CAPITAL PROJECTS 0 0 0 A 12890000 21170000 2270000 18900000 2012 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPRISED OF THE OFFICERS OF THE BOARD AND IS CHAIRED BY THE CHAIR OF THE BOARD. THEY ARE GIVEN AUTHORITY BY THE BOARD TO PERFORM SPECIFIC FUNCTIONS, INCLUDING THE ANNUAL REVIEW OF THE CEO. WHEN THE FULL BOARD CAN NOT MEET, IN AN EMERGENCY SITUATION, THEY ARE AUTHORIZED TO EXERCISE ALL POWER OF THE BOARD EXCEPT ACTIONS RELATED TO ELECTION OF OFFICER OR FILLING VACANCIES. FORM 990, PART VI, SECTION A, LINE 3 UNITED LUTHERAN PROGRAM FOR THE AGING, INC. HAS A CONTRACT WITH SODEXO TO MANAGE DINING SERVICES. SODEXO DIRECTLY EMPLOYS DINING MANAGEMENT EMPLOYEES, PURCHASES ALL FOOD, AND SUPERVISES LUTHER MANOR'S DINING SERVICE STAFF. FORM 990, PART VI, SECTION B, LINE 11B THE MEMBERS OF THE BOARD OF DIRECTORS OF UNITED LUTHERAN PROGRAM FOR THE AGING, INC. HAVE THE OPPORTUNITY TO REVIEW THE COMPLETE FORM 990 PRIOR TO BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND OFFICERS ANNUALLY REVIEW AND SIGN THE CONFLICT OF INTEREST POLICY, DISCLOSING ANY POTENTIAL CONFLICTS OF INTEREST TO THE SECRETARY OF THE BOARD AND ON AN INTERIM BASIS AS CONFLICTS ARISE AS OUTLINED IN THE POLICY. THE BOARD WILL REVIEW THE CONFLICT AND DETEMINE THE APPROPRIATE ACTION. DEPENDING ON THE TYPE OF CONFLICT, DIRECTORS AND OFFICERS WITH CONFLICTS MAY BE ALLOWED TO REMAIN ON THE BOARD, BUT WOULD BE EXPECTED TO REFRAIN FROM DISCUSSIONS OR VOTING ON MATTERS WHERE A POTENTIAL CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 15 AN OUTSIDE COMPENSATION CONSULTANT IS ENGAGED TO REVIEW COMPENSATION OF LIKE ORGANIZATIONS AND INDUSTRY COMPENSATION SURVEYS. BASED ON THIS DATA, COMPENSATION RECOMMENDATIONS ARE MADE TO THE EXECUTIVE COMMITTEE OF THE BOARD OF THE ULPA AND APPROVED BY THIS COMMITTEE. THE REVIEW WAS PERFORMED BY THE COMPENSATION CONSULTANT USING DATA FROM THE 2020 GUIDESTAR NONPROFIT COMPENSATION REPORT, THE 2020 LEADING AGE CEMO SURVEY AND RELEVANT DATA FROM FORM 990 FOR COMPARABLE ORGANIZATIONS. THE INFORMATION WAS DOCUMENTED BY THE EXECUTIVE COMMITTEE OF THE ULPA BOARD OF DIRECTORS IN A REBUTTABLE PRESUMPTION CHECKLIST. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS OF UNITED LUTHERAN PROGRAM FOR THE AGING, INC. ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION WILL CONSIDER REQUESTS AND MAKE THE DOCUMENTS AVAILABLE BASED ON FACTS AND CIRCUMSTANCES OF THE REQUEST. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS NOT MADE AVAILABLE TO THE PUBLIC. SOME YEAR-END FINANCIAL INFORMATION IS PROVIDED IN LUTHER MANOR'S ANNUAL IMPACT REPORT. FORM 990, PART XI, LINE 9: RISTRICTED CONTRIBUTIONS 72,718. LUTHER MANOR FOUNDATION 4545 NORTH 92ND STREET MILWAUKEE WI 53225 391499823 PROGRAM GRANT TO UNITED LUTHERAN PROGRAM FOR THE AGING, INC. WI 501(C)(3) LINE 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 1