2018-01-30T14:59:42-06:00 2017-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 W RESEARCH DRIVE STE 200 MILWAUKEE WI 53226 990 2016-07-01 391020547 CLEMENT MANOR INC CLEM 4143211800 3939 S 92ND STREET GREENFIELD WI 53228 DIANE LEPKOWSKI CFO 4143211800 2018-01-23 1 KIMBERLY ANDERSON CPA P00188889 4144761880 2018-01-23 67.137.57.251 2018-01-23 10:02:04 CS P C55B74F35761343DF3EAAF55A212E731524E6D60 AD160EB8B79CB3AB05C143433BD9CB5545900E11 2016 2021-01-29 14:40:06Z DIANE LEPKOWSKI 3939 S 92ND STREET GREENFIELD WI 53228 19340131 0 X WWW.CLEMENTMANOR.COM X 1963 WI CLEMENT MANOR IS A NON-PROFIT ORGANIZATION SPONSORED BY THE SCHOOL SISTERS OF ST. FRANCIS AND IS 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, ALWAYS KEEPING THE FACILITY AT THE FOREFRONT OF IMPROVEMENTS IN THE LONG TERM CARE INDUSTRY TO ENSURE THE BEST CARE POSSIBLE. CLEMENT MANOR IS ALSO AN ASSOCIATE MEMBER OF THE BENEDITINE HEALTH SYSTEM, A CATHOLIC HEALTH CARE ORGANIZATION WELL-KNOWN AND RESPECTED IN THE PROFESSION. 11 11 434 115 0 0 169785 148424 21709316 19111491 0 0 42239 40212 21921340 19300127 0 0 0 0 12813546 11924629 0 0 5022 8892321 8132131 21705867 20056760 215473 -756633 17804336 16797597 18875499 18625393 -1071163 -1827796 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 17538219 18674412 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 2017 WAS APPROXIMATELY $3,301,000. IN ADDITION, CLEMENT PROVIDED APPROXIMATELY $46,000 OF CHARITY CARE SERVICES TO THE NEEDY IN FISCAL 2017. 17538219 1 1 0 1 0 0 0 0 0 0 1 0 0 0 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 46 1 1 434 1 0 0 0 0 0 1 1 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X DIANE LEPKOWSKI 4143211800 3939 SOUTH 92ND STREET GREENFIELD WI 53228 AMY KESLER BOARD MEMBER 0.30 X 0 0 0 ANN MAHER BOARD MEMBER 0.30 X 0 0 0 SISTER JUDEEN SCHULTE BOARD SECRETARY 0.30 X X 0 0 0 KEVIN NITKA BOARD CHAIR 0.30 X X 0 0 0 DR CHRISTOPHER SCHULTZ BOARD MEMBER 0.30 X 0 0 0 SISTER CAROL GRANDLICH BOARD MEMBER 0.30 X 0 0 0 PHIL DOUGHERTY JR VICE CHAIR 0.30 X X 0 0 0 ALISSA KARL BOARD TREASURER 0.30 X X 0 0 0 SISTER ELIZABETH SCHMITZ BOARD MEMBER 0.30 X 0 0 0 KRISTA PANKOP BOARD MEMBER 0.30 X 0 0 0 SABRINA JOHNSON BOARD MEMBER 0.30 X 0 0 0 DENNIS FERGER PRESIDENT/CEO 40.00 X 210653 0 14595 DIANE LEPKOWSKI CFO 40.00 X 104230 0 3738 LAURE ZULKOWSKI DIRECTOR OF NURSING 40.00 X 109886 0 7127 BEBE CESCHI REGISTERED NURSE 40.00 X 101304 0 1773 526073 0 27233 4 0 1 0 REHABCARE GROUP 7733 FORSYTH BLVD ST LOUIS MO 63105 THERAPY SERVICES 1571394 ROESCHEN INTERMED PHARMACY 3433 DOUGLAS AVE RACINE WI 53402 PHARMACY SERVICES 303304 VJS CONSTRUCTION SERVICES W233 N2487 ROUNDY CIRCLE WEST PEWAUKEE WI 53072 CONSTRUCTION SERVICES 219345 ARAMARK UNIFORM SERVICES 25259 NETWORK PLACE CHICAGO IL 60673 LAUNDRY SERVICES 198236 CLEARPATH CONNECTIONS 1251 E WISCONSIN AVE PEWAUKEE WI 53072 COMMUNICATION SERVICES 108406 5 30079 118345 148424 RESIDENT SERVICE REVENUE 623000 16865233 16865233 RESIDENT ADMINISTRATIVE SERVICE R 623000 994242 994242 DAYCARE REVENUE 623000 498897 498897 RESIDENT FEES 623000 467597 316040 151557 MISCELLANEOUS RESIDENT SERVICES 623000 197270 197270 88252 88252 19111491 14848 0 14848 14848 14848 47304 30079 24374 22930 22930 18064 15630 2434 2434 19300127 18674412 0 477291 X 526073 109886 416187 9024205 8173776 850429 249431 216350 33081 1441403 1250235 191168 683517 592865 90652 2908 2908 38242 38242 2351481 2039613 311868 1840421 1554643 285778 1052126 1052126 18418 15975 2443 39735 34465 5270 408754 408754 1585752 1585752 191137 191137 MISCELLANEOUS 388972 289594 94356 5022 BAD DEBT EXPENSE 144001 144001 LEASES 70184 70184 20056760 17538219 2513519 5022 3130430 2433858 1361782 1021786 125501 129486 117510 243087 37881502 24950891 12808062 12930611 261051 38769 17804336 16797597 2610774 2279891 12439000 11093745 1451610 964393 864393 2861332 2935754 18875499 18625393 X -1101163 -1827796 30000 0 -1071163 -1827796 17804336 16797597 -756633 0 X X 0 1 X 1 0 X 148670 139948 143016 169785 148424 749843 21311355 21182433 20515960 21323164 18674412 103007324 462500 506932 442991 429992 478073 2320488 21922525 21829313 21101967 21922941 19300909 106077655 5000 5000 0 5000 5000 106072655 43158 42988 21505 17012 14848 139511 43158 42988 21505 17012 14848 139511 21965683 21872301 21123472 21939953 19315757 106217166 0.99860 0.99840 0.00130 0.00160 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1756 1756 0 PART II-B, LINE 1: PORTION OF DUES PAID TO AHCA, WICAL, AND WHCA EXPENDED FOR LOBBYING PURPOSES. 416932 416932 29370700 19451460 9919240 7853782 5271624 2582158 240088 227807 12281 12930611 DEFERRED REVENUE FROM ADVANCE FEES 2896985 DEFERRED COMPENSATION 38769 2935754 X 19315757 0 19315757 -15630 -15630 19300127 20072390 15630 15630 20056760 0 20056760 PART X, LINE 2: THE CORPORATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE CORPORATION IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, 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 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, 2017 AND 2016. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVENTORY COST OF GOODS SOLD -15,630. PART XII, LINE 2D - OTHER ADJUSTMENTS: INVENTORY COST OF GOODS SOLD 15,630. GOLF OUTING 60951 29639 31312 0 0 16128 0 0 4174 HOLIDAY BAZAAR 16432 440 15992 1000 0 0 1281 1791 2 77383 30079 47304 1000 16128 1281 5965 24374 22930 X X 0 1 0 0 0 0 0 0 0 DENNIS FERGER PRESIDENT/CEO 191285 0 0 0 19368 0 1547 0 13048 0 225248 0 0 0 PART III - SUPPLEMENTAL INFORMATION THE CORPORATION ALSO SPONSORS A DEFERRED COMPENSATION PROGRAM COVERING THE FORMER CHIEF EXECUTIVE OFFER, RICHARD RAU. INVESTMENTS, INCLUDED IN ASSETS LIMITED AS TO USE, AND THE CORRESPONDING LIABILITY TOTALING $38,769 AND $69,732 AS OF JUNE 30, 2017 AND 2016, RESPECTIVELY, ARE INCLUDED IN THE BALANCE SHEET. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2013-02-27 15580000 SEE PART VI 0 0 0 A 4309000 15580000 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 SCHEDULE K, PART I, BOND ISSUES: (F) DESCRIPTION OF PURPOSE: REFUND PRIOR ISSUE - 10/01/1998 $11,580,000; BUILDINGS AND STRUCTURES $2,741,620; EQUIPMENT WITH RECOVERY PERIOD OF MORE THAN 5 YEARS $1,140,380; LAND IMPROVEMENTS $118,000 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 18 THE ORGANIZATION WILL MAKE THEIR GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. 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 571,964. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 571,964. THERAPY SERVICES: PROGRAM SERVICE EXPENSES 905,019. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 905,019. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 42,703. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 42,703. RELIGIOUS SERVICES: PROGRAM SERVICE EXPENSES 20,439. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,439. CLEANING/LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 197,556. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 197,556. MAINTENANCE: PROGRAM SERVICE EXPENSES 301,932. MANAGEMENT AND GENERAL EXPENSES 292,165. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 594,097. CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 7,574. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,574. DATA PROCESSING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 12,129. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,129. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE OF THE BOARD RECOMMENDS THE AUDITING FIRM FOR THE CORPORATION AND ANY OF ITS RELATED ENTITIES TO THE BOARD FOR APPROVAL. THE BOARDS FORWARDS ITS APPROVAL AND RECOMMENDATION TO THE SSSF CORPORATE MEMBERS FOR FINAL APPROVAL. BOTH THE BOARD AND SSSF CORPORATE MEMBERS ACCEPT THE AUDIT REPORT. 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 0 0 0