2016-11-15T15:20:44-06:00 2016-06-30 390758449 Wipfli LLP 3703 Oakwood Hills Pkwy Eau Claire WI 54701 990 2015-07-01 391516772 Community Health Services Corporation COMM 6083263200 720 S Fremont Street Prairie Du Chien WI 53821 M Connie Achenbach Board Chairperson 6083263200 2016-11-15 1 DONNA NELSON CPA P00968978 7158323407 2016-11-15 2015 2017-02-10 21:41:12Z M CONNIE ACHENBACH 720 S Fremont Street Prairie Du Chien WI 53821 10598697 0 X www.chscwi.org X 1984 WI COMMUNITY HEALTH SERVICES CORPORATION IS A COMMUNITY OWNED ORGANIZATION WHICH WAS CREATED TO OVERSEE THE ACQUISITION, CONSTRUCTION, AND OPERATION OF RETIREMENT HOMES, SKILLED NURSING FACILITIES, AND HOUSING FOR PERSONS WITH SPECIFIC NEEDS. 9 9 299 85 0 0 3410 13028 9687750 10322377 10636 5877 1600 257415 9703396 10598697 0 0 0 0 6153405 6193507 0 0 0 3323719 3774185 9477124 9967692 226272 631005 15030623 15548312 1031478 918162 13999145 14630150 X TO HONOR THOSE ENTRUSTED TO OUR CARE WITH A WELCOME, CLEAN, COMFORTABLE ENVIRONMENT - A PLACE THEY WANT TO BE. 0 0 8012975 8869185 COMMUNITY HEALTH SERVICES CORPORATION OPERATES TWO SKILLED NURSING FACILITIES. PRAIRIE NURSING FACILITY, LLC (PRAIRIE MAISON) IS A 64-BED FACILITY LOCATED IN PRAIRIE DU CHIEN, WISCONSIN AND SANNES SKOGDALEN NURSING FACILITY, LLC (SANNES SKOGDALEN) IS A 50-BED FACILITY LOCATED IN SOLDIERS GROVE, WISCONSIN. BOTH FACILITIES OFFER AROUND-THE-CLOCK CARE FOR PERSONS WHO REQUIRE THE SERVICES OF PROFESSIONAL NURSING STAFF OR ARE UNABLE TO LIVE INDEPENDENTLY. THE NURSING STAFF INCLUDES REGISTERED AND LICENSED NURSES, AS WELL AS CERTIFIED NURSING ASSISTANTS, WORKING AS A TEAM TO PROVIDE THE HIGHEST QUALITY CLINICAL AND PERSONAL CARE. SKILLED AND INTERMEDIATE SERVICES INCLUDE CARE FOR THOSE NEEDING LONG-TERM CARE, AND THOSE NEEDING OBSERVATION BY LICENSED NURSING STAFF AND/OR PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY SERVICES. SKILLED AND INTERMEDIATE RESIDENTS ADDITIONALLY ENJOY A PERSON-CENTERED ACTIVITY PROGRAM, AN EXCEPTIONAL DINING PROGRAM, AND THE SERVICES OF A LICENSED SOCIAL WORKER. PRAIRIE MAISON HAD A TOTAL OF 22,625 OF RESIDENT DAYS AND SANNES SKOGDALEN HAD A TOTAL OF 17,371 RESIDENT DAYS DURING FISCAL YEAR 2016. AS AN EXTENSION OF SERVING THE NEEDS OF SENIORS IN THE LOCAL COMMUNITIES, THE NURSING FACILITIES PREPARE MEALS TO SERVE AT A SENIOR MEAL SITE, AND SOME ARE DELIVERED TO THE HOMEBOUND. 1058916 2021897 COMMUNITY HEALTH SERVICES CORPORATION OPERATES PRAIRIE MEMORIAL HOUSING, LLC LOCATED IN PRAIRIE DU CHIEN, WISCONSIN. PRAIRIE MEMORIAL HOUSING, LLC IS AN ASSISTED LIVING FACILITY WITH 24 RESIDENTIAL CARE APARTMENT COMPLEX UNITS AND 18 COMMUNITY BASED RESIDENTIAL FACILITY UNITS. THE ASSISTED LIVING COMBINES THE CARE OF ATTENTIVE STAFF WITH A SECURE AND SOOTHING ENVIRONMENT. PRIVATE BEDROOMS ARE ARRANGED AROUND A CENTRAL DINING AREA, KITCHEN AND LIVING ROOM, WITH WIDE HALLWAYS AND ROOMS THAT ARE EASY TO RECOGNIZE AND NAVIGATE. A SECURE COURTYARD ENABLES RESIDENTS TO ENJOY FRESH AIR, GARDENS AND GRASS. SERVICES AND AMENITIES PROVIDED AT BLUFF HAVEN INCLUDE 24 HOUR NURSING CARE, ASSISTANCE WITH ACTIVITIES OF DAILY LIVING, LAUNDRY, HOUSEKEEPING, PERSON-CENTERED ACTIVITIES, NURSING ASSISTANCE, CARE PLANNING, MEDICATION MANAGEMENT, NURSE CALL SYSTEM, SECURE ENVIRONMENT, AND AN OUTDOOR ENCLOSED PATIO AREA. THOSE NEEDING SKILLED CARE CAN TRANSITION TO THE SKILLED NURSING FACILITY LOCATED IN THE SAME BUILDING.COMMUNITY HEALTH SERVICES CORPORATION ALSO OPERATES LABATISSE APARTMENTS LOCATED IN PRAIRIE DU CHIEN, WISCONSIN. LABATISSE IS DESIGNED AS AN ELDERLY HOUSING OPTION FOR THOSE 50 YEARS OF AGE AND OLDER WHO ARE CAPABLE OF INDEPENDENT LIVING. THE APARTMENTS FEATURE A SECURE ENTRY, ON-SITE COIN OPERATED LAUNDRY, AND OFF STREET ASSIGNED PARKING. THE COMMUNITY ROOM AND SUN ROOM ALLOW SPACIOUS AREAS FOR TENANTS TO SOCIALIZE AND GATHER WITH FRIENDS AND FAMILY. LABATISSE OFFERS 22 ONE BEDROOM APARTMENTS AND 2 TWO BEDROOM APARTMENTS. 9071891 1 0 0 1 0 0 0 0 0 0 1 0 0 0 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 1 0 0 0 0 1 20 0 299 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X Lavern Bird 6083268471 720 S Fremont Street Prairie Du Chien WI 53821 Dr Mark Grunwald Trustee 1.00 X 0 0 0 Joe Atkins treasurer 2.00 X X 0 0 0 Pete Flesch Trustee 1.00 X 0 0 0 Dr Joyce Czajkowski Trustee 1.00 X 0 0 0 lavern bird ADMINISTRATOR 45.00 X X 15601 0 1177 MC Achenbach CHAIRPERSON 2.00 X X 0 0 0 Mike Davis TRUSTEE 1.00 X 0 0 0 Sara Ryan TRUSTEE 1.00 X X 0 0 0 steve jansen TRUSTEE 1.00 X 0 0 0 ALESHA ERDENBERGER ADMINISTRATOR 45.00 X 53760 0 19594 BARRY METEVIA PRESIDENT (through 3/11/16) 45.00 X 76905 0 8313 JACqueline CARLEY CFO/ADMINISTRATOR (through 2/26/16) 45.00 X 88131 0 17976 MARY JO WOLCOTT ADMINISTRATOR (through 9/24/15) 45.00 X 74252 0 6561 ROBERT SEVERSON VICE CHAIRSPERSON 1.00 X 0 0 0 308649 0 53621 0 0 0 0 Aegis Therapies Inc PO Box 8103 Fort Smith AR 72902 Physical, Occupational, and Speech Thera 615142 1 13028 13028 Nursing Home Revenue 623000 8869185 8869185 ELDERLY HOUSING REVENUE 623000 1315443 1315443 APARTMENT REVENUE 623990 137749 137749 10322377 5877 5877 8035 0 8035 8035 8035 INSURANCE PROCEEDS 623000 249380 249380 249380 10598697 10571757 0 13912 356104 356104 4637332 4474207 163125 24302 21776 2526 772915 741179 31736 402854 364661 38193 75 75 28285 28285 18689 18689 116907 116907 11601 11601 284860 281048 3812 44234 26693 17541 128 128 587814 587814 65671 65671 Supplies & Purchased Se 1560708 1545421 15287 Food 471811 471811 Bad Debt Expense 309778 309778 Bed Assessment 232560 232560 41064 14815 26249 9967692 9071891 895801 0 9967692 9071891 895801 0 128753 167855 3194486 2725783 922204 957919 55979 57470 80855 64595 17107387 5532697 10648346 11574690 15030623 15548312 598320 696004 433158 222158 1031478 918162 X 13999145 14630150 13999145 14630150 15030623 15548312 631005 0 X X 0 1 X 1 0 X 12169 4923 4232 3410 13028 37762 9691609 9491920 9530918 9688509 10322377 48725333 995 995 9704773 9496843 9535150 9691919 10335405 48764090 0 0 0 48764090 17257 18597 16043 12236 13912 78045 17257 18597 16043 12236 13912 78045 9722030 9515440 9551193 9704155 10349317 48842135 0.99840 0.99690 0.00160 0.00180 X 0 0 0 0 0 0 0 0 1 792 792 0 Part II-B, Line 1: COMMUNITY HEALTH SERVICES CORPORATION PAYS ANNUAL ASSOCIATION DUES TO LEADINGAGE WISCONSIN, INC. THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATION MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL INDUSTRY ENVIRONMENT. 354908 354908 13797535 3469715 10327820 2954944 2062982 891962 11574690 Form 990, Part VI, Section A, line 8b There are no committees of the Board of Directors which have authority to act on behalf of the entire governing body. Form 990, Part VI, Section B, line 11 The Form 990 is distributed to the board of directors for review at the board meeting prior to the 990 being submitted. Form 990, Part VI, Section B, line 12c Key employee conflict of interest statements are reviewed by the executive team and Board Of Directors. Board of Director's conflict of interest statements are reviewed by the President and Board of Directors. If a conflict is deemed to exist, the member must excuse themselves from discussion and voting on the topic. Form 990, Part VI, Section B, line 15 Community Health Services Corporation's Board of Directors sets the initial salary and benefit package for the administrators and president when they are hired. Market data and comparability data are used to determine a competitive salary and benefit package. In years subsequent to initial hire, administrative personnel receive the same cost of living salary increase as the rest of Community Health Services Corporation's employees which is approved by the Board of Directors annually. Form 990, Part VI, Section C, line 19 The financial statements and governing documents are available to the public upon request. Form 990, Part XI, Line 2c: Oversight of the Independent Accountant: The board of directors of Community Health Services Corporation reviews the audited financial statements at its board meeting and is responsible for the oversight and selection of the independent accountant. The board also takes time during the presentation of the annual financial statements to meet with the independent auditors. This process has not changed from the prior year. Sannes Skogdalen Nursing Facility LLC 101 Sunshine Blvd Soldiers Grove WI 54655 383708039 Nursing Home WI 3702471 2016142 N/A Prairie Nursing Facility LLC 700 s Fremont St Prairie Du Chien WI 53821 201532236 Nursing Home WI 5164906 1429197 N/A Prairie Memorial Housing LLC 720 S Fremont St Prairie Du Chien WI 53821 391516772 Elderly Housing WI 1461196 1552831 N/A