2014-11-13T14:11:21-06:00 2014-06-30 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PARKWAY EAU CLAIRE WI 54701 990 2013-07-01 391516772 COMMUNITY HEALTH SERVICES CORPORATION COMM 6083263200 720 S FREMONT STREET PRAIRIE DU CHIEN WI 53821 M CONNIE ACHENBACH BOARD CHAIRPERSON 6083263200 2014-11-11 1 HOLLY POKRANDT CPA P00449155 7158323407 2014-11-11 2013 2015-11-30 17:44:51Z M CONNIE ACHENBACH 720 S FREMONT STREET PRAIRIE DU CHIEN WI 53821 9551443 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. 8 8 278 85 0 0 4923 4232 9491920 9530918 13797 11493 4800 4800 9515440 9551443 0 0 0 0 5979531 6017194 0 0 0 3486315 3494668 9465846 9511862 49594 39581 14993690 15030037 1260398 1257164 13733292 13772873 X TO PROVIDE FOR THE ACQUISITION, CONSTRUCTION, AND OPERATION OF RETIREMENT HOMES, SKILLED NURSING FACILITIES, AND HOUSING FOR PERSONS WITH SPECIFIC NEEDS, AND THE PROVISION OF OTHER COMMUNITY SERVICES. 0 0 7895366 8439555 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 22,548 RESIDENT DAYS AND SANNES SKOGDALEN HAD A TOTAL OF 17,012 RESIDENT DAYS DURING FISCAL YEAR 2014. 716652 1091363 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 6 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. 8612018 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 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 22 0 278 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X JACQUELINE CARLEY 6086245244 720 S FREMONT STREET PRAIRIE DU CHIEN WI 53821 MIKE DAVIS DIRECTOR 1.00 X 0 0 0 PHYLIS IVERSON DIRECTOR 1.00 X 0 0 0 KATHY LEARD DIRECTOR 1.00 X 0 0 0 CINDY STANDORF DIRECTOR (THROUGH 11/2013) 1.00 X 0 0 0 DR MARK GRUNWALD DIRECTOR (THROUGH 7/2013) 1.00 X 0 0 0 STEVE JANSEN DIRECTOR 1.00 X 0 0 0 LAVERN BIRD DIRECTOR 1.00 X 0 0 0 BILL SEXTON DIRECTOR (THROUGH 11/2013) 1.00 X 0 0 0 JULIA NELSON DIRECTOR (THROUGH 11/2013) 1.00 X 0 0 0 KATIE GARRITY DIRECTOR (THROUGH 11/2013) 1.00 X 0 0 0 MC ACHENBACH CHAIRPERSON 2.00 X X 0 0 0 ROBERT SEVERSON VICE CHAIRPERSON 1.00 X X 0 0 0 SARA RYAN SECRETARY 1.00 X X 0 0 0 JOE ATKINS TREASURER 2.00 X X 0 0 0 BARRY METEVIA PRESIDENT 40.00 X 81314 0 9066 JACQUELINE CARLEY CFO/ADMINISTRATOR 40.00 X 82411 0 19843 MARY JO WOLCOTT ADMINISTRATOR 40.00 X 77111 0 22267 ALESHA ERDENBERGER ADMINISTRATOR 40.00 X 50588 0 20522 291424 0 71698 0 0 0 0 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH TX 72902 THERAPY SERVICES 869535 1 4232 4232 NURSING HOME REVENUE 623000 8439555 8439555 ELDERLY HOUSING REVENU 623000 963767 963767 APARTMENT REVENUE 623990 127596 127596 9530918 11243 11243 4800 0 4800 4800 4800 250 0 250 250 250 9551443 9530918 0 16293 363120 363120 4342086 4147730 194356 29559 29559 855564 825876 29688 426865 382112 44753 4540 4540 17305 17305 237292 232177 5115 12120 12120 120342 120342 276693 275352 1341 28511 14624 13887 72 72 574865 574865 66114 66114 SUPPLIES & PURCHASED SE 1363426 1363426 FOOD 439383 439383 BED ASSESSMENT 237448 237448 BAD DEBT EXPENSE 85499 85499 31058 3895 27163 9511862 8612018 899844 0 379870 147292 2365324 3063915 919813 1056094 63118 62963 73654 17620 15127437 4453772 11184351 10673665 7560 8488 14993690 15030037 716892 824006 543506 433158 1260398 1257164 X 13733292 13772873 13733292 13772873 14993690 15030037 39581 0 X X 0 1 X 1 0 X 5518 5565 12169 4923 4232 32407 8479390 9335955 9691609 9491920 9530918 46529792 995 995 8484908 9341520 9704773 9496843 9535150 46563194 0 0 0 46563194 18101 16708 17257 18597 16043 86706 18101 16708 17257 18597 16043 86706 2774 49991 52765 8505783 9408219 9722030 9515440 9551193 46702665 0.99700 0.99290 0.00190 0.00550 X 0 0 0 0 0 0 0 0 1 437 437 0 PART II-B, LINE 1: COMMUNITY HEALTH SERVICES CORPORATION PAYS ANNUAL ASSOCIATION DUES TO THE WISCONSIN HEALTH CARE ASSOCIATION, INC. AND 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 12028728 2761357 9267371 2743801 1692415 1051386 10673665 X PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, COMMUNITY HEALTH SERVICES CORPORATION DETERMINES 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 CONSOLIDATED FINANCIAL STATEMENTS. COMMUNITY HEALTH SERVICES CORPORATION HAS NOT RECORDED ANY ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2014 AND 2013. FEDERAL TAX RETURNS FOR THE YEARS 2011, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 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 COMMUNITY HEALTH SERVICES CORPORATION REQUIRES ITS BOARD MEMBERS TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. 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 3538682 1599916 N/A PRAIRIE NURSING FACILITY LLC 700 S FREMONT ST PRAIRIE DU CHIEN WI 53821 201532236 NURSING HOME WI 4899827 1744525 N/A PRAIRIE MEMORIAL HOUSING LLC 720 S FREMONT ST PRAIRIE DU CHIEN WI 53821 391516772 ELDERLY HOUSING WI 1093325 1274570 N/A