2015-09-29T11:55:20-05:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2014-01-01 390874802 LINCOLN LUTHERAN OF RACINE INC LINC 2626330500 2000 DOMANIK DRIVE RACINE WI 53406 MIKE POLSKY RECEIVER RECEIVER 2626330500 2015-09-24 1 KIMBERLY ANDERSON CPA P00188889 6086628600 2015-09-23 2014 2016-04-25 22:37:26Z MIKE POLSKY 2000 DOMANIK DRIVE RACINE WI 53406 11433985 0 X WWW.LINCOLNLUTHERAN.COM X 1954 WI LINCOLN LUTHERAN OF RACINE CONSISTS OF A SKILLED NURSING FACILITY WHICH HAS 120 BEDS. IT ALSO CONSISTS OF COMMUNITY SERVICE PROGRAMS WHICH ARE ADULT DAY SERVICES, HOMELINC, AND HARMONY CLUB. 11 10 301 500 0 0 440848 359476 11598048 8872885 322990 163999 1519722 2037625 13881608 11433985 0 0 0 0 7828826 6759368 0 0 23715 6635390 6500752 14464216 13260120 -582608 -1826135 15104410 13755419 11024066 11499346 4080344 2256073 X LINCOLN LUTHERAN OF RACINE CONSISTS OF A SKILLED NURSING FACILITY WHICH HAS 120 BEDS. IT ALSO HAS COMMUNITY SERVICE PROGRAMS WHICH INCLUDE ADULT DAY SERVICE PROGRAMS, HARMONY CLUB, AND HOMELINC. 0 0 7139239 6627468 LINCOLN VILLAGE IS A SKILLED NURSING FACILITY THAT SPECIALIZES IN SHORT TERM REHABILITATION. IT IS A CERTIFIED MEDICARE AND MEDICAID FACILITY. IT OFFERS A COMPREHENSIVE REHABILITATION PROGRAM TO MAXIMIZE YOUR FUNCTIONAL ABILITIES AND QUALITY OF LIFE. WE PROVIDE A THERAPY TEAM THAT CONSISTS OF OCCUPATIONAL, PHYSICAL, AND SPEECH THERAPISTS. 999497 1805872 LINCOLN LUTHERAN OFFERS COMMUNITY SERVICES FOR THE ELDERLY AND HANDICAPPED. THIS INCLUDES AN ADULT DAY SERVICES PROGRAM IN RACINE AND WESTERN RACINE COUNTY. IT ALSO PROVIDES IN HOME NON NURSING CARE THROUGH THE HOMELINC PROGRAM AND HARMONY CLUB WHICH IS A SOCIAL DAY PROGRAM. IT IS A PROVIDER OF MEALS THROUGH IT'S MEALS ON WHEELS AND NUTRITION SITE PROGRAMS. 774046 612660 LINCOLN VILLAS REDEVELOPMENT IS A DISREGARDED ENTITY OF LINCOLN LUTHERAN OF RACINE WHICH WAS PURCHASED IN 2010. THIS IS A 99 UNIT LOW INCOME HOUSING PROJECT. THE PROJECT IS REGULATED BY THE US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 1849983 OTHER PROGRAM SERVICES INCLUDE SERVICE COORDINATORS FOR OUR HUD PROJECTS. 1849983 8912782 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1 29 0 1 301 1 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 WI X BECK CHAET BAMBERGER & POLSKY SC 4142734200 TWO PLAZA EAST SUITE 1085 330 E MILWAUKEE WI 53202 DAVE TITUS BOD-PRESIDENT 1.00 6.00 X 0 0 0 MORRIS REECE BOD-VICE PRESDIENT 1.00 6.00 X 0 0 0 DANA O'BRIEN BOD-SECRETARY 1.00 6.00 X 0 0 0 RAYMOND KOUKARI JR BOD-TREASURER 1.00 6.00 X 0 0 0 CHERYL THOMAS BOD-MEMBER AT LARGE 1.00 6.00 X 0 0 0 GREGORY MUELLER BOARD MEMBER 1.00 6.00 X 0 0 0 JEFFREY COLLEN BOARD MEMBER 1.00 6.00 X 0 0 0 KRYSTYNA SARRAZIN BOARD MEMBER 1.00 6.00 X 0 0 0 EMMANUEL OTU BOARD MEMBER 1.00 6.00 X 0 0 0 DAVID ISSACSON BOARD MEMBER 1.00 6.00 X 0 0 0 DANIEL RISCH FORMER CEO 35.00 5.00 X 109024 0 6976 CARLOYN SEEGER SENIOR VP 40.00 X 92288 0 5842 MARION PATTERSON VP-HR 40.00 X 100323 0 6826 MICHELLE PUTZ INTERIM CEO 40.00 X 142092 0 11532 443727 0 31176 3 0 1 0 SODEXO INC & AFFILIATES 4880 PAYSHERE CIRCLE CHICAGO IL 60674 DINING SERVICES 546232 REHAB CARE GROUP INC SRS DIVISION ST LOUIS MO 63150 THERAPY SERVICES 399451 REINHART BOERNER VAN DUEREN 1000 NORTH WATER STREET SUITE 1700 MILWAUKEE WI 53202 LEGAL SERVICES 169242 SPECIALIZED MEDICAL SERVICES 7237 SOLUTION CENTER CHICAGO IL 60677 CONSULTING SERVICES 140249 ADP INC PO BOX 842875 BOSTON MA 02284 PAYROLL SERVICES 113804 5 234585 124891 359476 LINCOLN VILLAGE 623000 6454353 6454353 COMMUNITY SERVICE 624100 1805872 1805872 LINCOLN VILLAS REDEVELOPMENT 531110 612660 612660 8872885 146541 146541 11338 11338 86220 0 86220 86220 86220 7609 9849 0 0 7609 9849 17458 17458 3189 0 3189 3189 MANAGEMENT FEE 561000 1849983 1849983 LAUNDRY & TENANT REVENUE 812300 34536 34536 52359 52359 1936878 11433985 10895983 0 178526 519190 519190 4632993 4052469 562473 18051 68093 68093 1044601 835269 209251 81 494491 400255 92822 1414 1152024 55798 1096226 517695 12 517683 66192 9500 56692 877456 416809 460647 18767 16515 1028 1224 304831 172616 130885 1330 80846 56169 24677 367427 290888 76539 29412 29392 20 20095 1448 18622 25 310457 148765 161692 382516 300624 81892 283730 209753 73977 DIETARY 599120 599120 IMPAIRMENT/WI PROVIDER/ 289385 279654 9731 THERAPY (OT,PT,ST)/SUPP 256196 256196 BAD DEBT 170888 170888 773715 640034 132111 1570 13260120 8912782 4323623 23715 548381 665295 1004446 813429 1172994 411691 2924023 3185714 31897 38925 142227 159539 13778454 6936211 7151926 6842243 487491 0 1641025 1638583 15104410 13755419 2788447 3687538 242948 101040 6420892 6745062 1571779 965706 11024066 11499346 X 4080344 2256073 4080344 2256073 15104410 13755419 -1826135 1864 0 X X 0 0 1 0 X 661412 661412 9601085 3960884 5640201 486819 330703 156116 2954453 2596398 358055 74685 48226 26459 6842243 FINANCIAL COSTS NET 45299 INVESTMENT IN SIENA ON THE LAKE 1593284 1638583 RESIDENTIAL CUSTODIAL ACCOUNTS 21002 SECURITY DEPOSITS 28302 DUE TO AFFILIATES 916402 965706 X 1 1 X X 0 0 0 0 0 0 0 0 0 MICHELLE PUTZ INTERIM CEO 122094 0 19998 0 0 0 7511 0 4021 0 153624 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 LINCOLN LUTHERAN HAS SEVERAL MEMBER CONGREGATIONS. THESE CONGREGATIONS DELEGATE AUTHORITY TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS MAY ELECT OTHER MEMBERS TO THE BOARD FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION IS CURRENTLY IN RECEIVERSHIP, SO THERE IS NO GOVERNING BOARD. THE APPOINTED RECEIVER WILL REVIEW THE FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION PERFORMS A REVIEW TO ENSURE COMPLIANCE FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION HAS A COMPENSATION COMMITTEE, WHICH IS PART OF THE BOARD OF DIRECTORS. SALARIES ARE DETERMINED BY PERFORMANCE APPRAISALS AND MARKET DATA FROM ASSOCIATIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION HAS THIS INFORMATION AVAILABLE UPON REQUEST FORM 990, PART XII, LINE 3B: LINCOLN LUTHERAN DID NOT UNDERGO THE REQUIRED FINANCIAL STATEMENT AUDIT DUE TO FILING A CHAPTER 128 RECEIVERSHIP ON 12/30/2014. LINCOLN VILLAS REDEVELOPMENT LLC 2000 DOMANIK DR RACINE WI 53404 383781716 DEVELOPMENT COMPANY WI 617264 6611833 LINCOLN LUTHERAN OF RACINE LINCOLN LUTHERAN COMMUNITY CARE 2000 DOMANIK DR RACINE WI 53404 391674718 NURSING HOME WI 501(C)(3) LINE 9 LINCOLN LUTHERAN OF RACINE 1 TRINITY TERRACE 2000 DOMANIK DR RACINE WI 53404 391667734 LOW INCOME HOUSING WI 501(C)(3) LINE 9 LINCOLN LUTHERAN OF RACINE 1 LINCOLN VILLAS NORTH INC 2000 DOMANIK DR RACINE WI 53404 391363010 LOW INCOME HOUSING WI 501(C)(3) LINE 9 LINCOLN LUTHERAN OF RACINE 1 LINCOLN LUTHERAN CHARITABLE TRUST 2000 DOMANIK DR RACINE WI 53404 391316328 INVESTMENTS FOR LINCOLN LUTHERAN WI 501(C)(3) LINE 9 LINCOLN LUTHERAN OF RACINE 1 ATRIUM OF RACINE INC 2000 DOMANIK DR RACINE WI 53404 391615970 INDEPENDENT HOUSING/ASSISTED LIVING WI 501(C)(3) LINE 9 LINCOLN LUTHERAN OF RACINE 1 SIENA OF THE LAKE 2000 DOMANIK DR RACINE WI 53404 452814682 SENIOR SERVICES WI 501(C)(3) LINE 9 LINCOLN LUTHERAN OF RACINE 1 LINCOLN MANOR REDEVELOPMENT LLC 2000 DOMANIK DRIVE RACINE WI 53404 LOW INCOME HOUSING WI LINCOLN LUTHERAN OF RACINE RELATED 27 153 0 1 0.00010 LVR DEVELOPER LLC 2000 DOMANIK DRIVE RACINE WI 53404 800553461 LOW INCOME HOUSING WI LINCOLN LUTHERAN OF RACINE RELATED 55519 0 1 0.99990 LMR MANAGING MEMBER 2000 DOMANIK DR RACINE WI 53404 203502780 MANAGING MEMBER WI LINCOLN LUTHERAN OF RACINE C 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 LINCOLN LUTHERAN COMMUNITY CARE CORPORATION Q 497513 ACTUAL LINCOLN MANOR Q 57433 ACTUAL LINCOLN VILLAS NORTH Q 41683 ACTUAL TRINITY TERRACE Q 21995 ACTUAL ATRIUM OF RACINE INC Q 174958 ACTUAL