2021-11-15T21:35:50-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2020-01-01 390806344 FOND DU LAC LUTHERAN HOME INC FOND 9209219520 1045 HILL STREET WATERTOWN WI 53098 TERRY SCHLEIF CHAIR 9209219520 2021-11-04 1 TERRY SCHLEIF 999009999 KIMBERLY ANDERSON P00188889 6086628600 2021-11-04 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z TERRY SCHLEIF 1045 HILL STREET WATERTOWN WI 53098 8442752 0 X WWW.LUTHERANHOMESFONDDULAC.ORG X 1939 WI FOND DU LAC LUTHERAN HOME, AS PART OF LUTHERAN HOMES AND HEALTH SERVICES, PROVIDES A CHRISTIAN-BASED INNOVATIVE APPROACH TO AGING THROUGH COMPREHENSIVE SERVICES, PROGRAMS, AND COMMUNITIES. 6 6 119 57 0 0 4287 1378346 7405448 6755212 3566 1234 25659 307960 7438960 8442752 0 0 0 0 3226533 3052928 0 0 0 4797013 4143448 8023546 7196376 -584586 1246376 4833246 6906774 1250388 2077540 3582858 4829234 X FOND DU LAC LUTHERAN HOME, AS PART OF LUTHERAN HOMES AND HEALTH SERVICES, PROVIDES A CHRISTIAN-BASED INNOVATIVE APPROACH TO AGING THROUGH COMPREHENSIVE SERVICES, PROGRAMS, AND COMMUNITIES. 0 0 5912443 6807697 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, A LHHS ENTITY, PROVIDES SKILLED NURSING, SHORT-TERM REHABILITATION, AND ASSISTED LIVING 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. 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 15,545 MEDICAID DAYS, 2,350 MEDICARE DAYS AND 21,443 TOTAL NURSING HOME DAYS IN 2020. THE FOND DU LAC LUTHERAN HOME'S ASSISTED LIVING PROGRAM TARFA TERRACE 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 8,768 BED DAYS IN 2020. 5912443 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 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 1 0 0 0 1 8 0 119 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X JULIE MARKS 9203228527 1045 HILL STREET WATERTOWN WI 53098 X TERRY SCHLEIF CHAIR 1.50 1.50 X X 0 0 0 JIM FETT BOARD MEMBER 0.25 0.25 X 0 0 0 MIKE KROLCZYK BOARD MEMBER 0.25 0.25 X 0 0 0 BETH MANNEBACH BOARD MEMBER 0.25 0.25 X 0 0 0 KIM SUHS VICE CHAIR 1.00 1.00 X X 0 0 0 0 0 0 0 0 0 0 MARQUARDT MANAGEMENT SERVICES 1045 HILL STREET WATERTOWN WI 53098 MANAGEMENT SERVICES 1013567 NEW HORIZON FOODS PO BOX 860246 MINNEAPOLIS MN 55486 FOOD SERVICES 782865 SYMBRIA REHAB 28100 TORCH PARKWAY SUITE 600 WARRENVILLE IL 60555 THERAPY PROVIDER 395661 OMNICARE INC PO BOX 78000 DETROIT MI 48278 PHARMACY 217516 ELIM PREFERRED SERVICES INC 3500 HOLLY LANE SUITE 30 PLYMOUTH WI 55447 MEDICAL SUPPLIES 100780 5 21992 1356354 1378346 NURSING HOME 623000 5753205 5753205 RESIDENTIAL FACILITY 623000 996941 996941 BEAUTY SHOP REVENUE 900099 5066 5066 6755212 1234 1234 FORGIVENESS OF INTERCO 900099 250409 250409 MISC REVENUE 623000 57551 57551 307960 8442752 6807697 0 256709 X 2644742 2454647 190095 17455 16214 1241 192123 178049 14074 198608 184377 14231 666380 666380 7323 7323 39948 39948 1461612 1393405 68207 14637 14637 13742 2059 11683 202406 173760 28646 7154 3932 3222 22881 22881 304499 304499 98659 82615 16044 SUPPLIES 710306 710306 BAD DEBT EXPENSE 321691 321691 BED ASSESSMENT 192440 192440 REPAIRS AND MAINTENANCE 40574 40574 39196 8797 30399 7196376 5912443 1283933 0 419990 2729347 875680 816214 70529 103619 15120117 12249875 3053023 2870242 414024 387352 4833246 6906774 599000 1549275 651388 528265 1250388 2077540 X 3582858 4829234 3582858 4829234 4833246 6906774 1246376 0 X 0 1 X 1 0 X 5 9812 4287 1378346 1392450 7758109 8468120 8317534 7405448 6755212 38704423 7758109 8468125 8327346 7409735 8133558 40096873 0 215880 255224 112394 488749 274839 1347086 215880 255224 112394 488749 274839 1347086 38749787 640 803 1731 3566 1234 7974 640 803 1731 3566 1234 7974 51766 76122 518170 25659 307960 979677 7810515 8545050 8847247 7438960 8442752 41084524 0.94320 0.95080 0.00020 0.00020 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 89363 89363 10798128 8518522 2279606 4119577 3642596 476981 113049 88757 24292 2870242 UNEMPLOYMENT COMP DEPOSIT 359053 DUE FROM LUTHERAN HOMES AND HEALTH SERVICES 28299 387352 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SINGLE CLASS OF MEMBERS, AND THE SOLE MEMBER OF THAT CLASS IS LUTHERAN HOMES & HEALTH SERVICES, INC, A WISCONSIN NONSTOCK CORPORATION (THE "MEMBER"). FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OF THE BOARD OF DIRECTORS SHALL BE APPOINTED BY THE MEMBER WITH CONSIDERATION GIVEN TO THEIR CHARACTER, CONCERN FOR THE PRINCIPLES AND PROGRAMS OF THE CORPORATION, AND THE SINGULAR CONTRIBUTIONS THEY COULD RENDER TO THE INCREASED EFFECTIVENESS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT REVIEWS THE FORM 990. THE FORM 990 IS THEN PROVIDED TO THE BOARD MEMBERS ELECTRONICALLY FOR THEIR REVIEW IN ADVANCE OF THE BOARD MEETING AND REVIEWED AS INDICATED IN THE BOARD MINUTES, BEFORE IT IS FINALIZED. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY AT A REGULARLY SCHEDULED BOARD MEETING, ALL BOARD MEMBERS ARE GIVEN A 'CONFLICT OF INTEREST' STATEMENT TO SIGN. PRIOR TO THE SIGNING, EACH BOARD MEMBER IS BRIEFED ON THE PURPOSE AND INTENT OF THE FORM AND THE NEED TO LIST ANY PERSONAL CONTACTS AND/OR INTEREST THAT MAY CONFLICT WITH THEIR ABILITY TO SERVE AS BOARD MEMBERS. THOSE THAT HAVE NOT ATTENDED THE BOARD MEETING WOULD BE CONTACTED PERSONALLY WITH SIMILAR INSTRUCTIONS. ALL SIGNED DOCUMENTS ARE RETAINED. ALL BOARD MEMBERS SIGN AND COMPLETE THE FORM. MANAGEMENT FOLLOWS UP ON ANY CONFLICTS THAT ARE IDENTIFIED. FORM 990, PART VI, SECTION B, LINE 15 BOARD AND CEO REVIEW COMPARABILITY DATA AND APPROVE COMPENSATION ANNUALLY. 2020 IS THE MOST RECENT YEAR REVIEW WAS PERFORMED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,393,405. MANAGEMENT AND GENERAL EXPENSES 68,207. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,461,612. LUTHERAN HOMES AND HEALTH SERVICES INC 1045 HILL STREET WATERTOWN WI 53098 392032901 PROVIDE MANAGEMENT SERVICES TO FOND DU LAC LUTHERAN HOME, INC WI 501(C)(3) LINE 10 N/A 0 LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION INC 1045 HILL STREET WATERTOWN WI 53098 391466308 FUND DEVELOPMENT WI 501(C)(3) LINE 7 LUTHERAN HOMES AND HEALTH SERVICES INC 0 0 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0