2013-01-09T15:48:12-06:00 2012-06-30 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PARKWAY EAU CLAIRE WI 54701 990 2011-07-01 391516772 COMMUNITY HEALTH SERVICES CORPORATION COMM 6083263200 720 S FREMONT STREET PRAIRIE DU CHIEN WI 53821 M CONNIE ACHENBACH 6083263200 2012-12-17 1 HOLLY POKRANDT CPA P00449155 7158323407 2012-12-17 2011 2016-03-07 17:11:31Z M CONNIE ACHENBACH 720 S FREMONT STREET PRAIRIE DU CHIEN WI 53821 9722030 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 9 257 85 0 0 5565 12169 9335955 9691609 16708 15657 49991 2595 9408219 9722030 0 0 0 0 6200906 6280615 0 0 0 3601064 3468285 9801970 9748900 -393751 -26870 14989850 14957875 1279282 1274177 13710568 13683698 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 8281955 8857668 COMMUNITY HEALTH SERVICES CORPORATION OPERATES TWO SKILLED NURSING FACILITIES. PRAIRIE MAISON IS A 64 BED FACILITY LOCATED IN PRAIRIE DU CHIEN, WISCONSIN AND SANNES SKOGDALEN IS A 63 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 21,885 RESIDENT DAYS AND SANNES SKOGDALEN HAD A TOTAL OF 21,933 RESIDENT DAYS DURING FISCAL YEAR 2012. 584628 833941 COMMUNITY HEALTH SERVICES CORPORATION OPERATES PRAIRIE MEMORIAL HOUSING LOCATED IN PRAIRIE DU CHIEN, WISCONSIN. PRAIRIE MEMORIAL HOUSING 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. 8866583 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 0 1 23 0 1 257 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 WI X JACKIE CARLEY 6083268472 720 S FREMONT STREET PRAIRIE DU CHIEN WI 53821 HAROLD BROWN 1.00 X 0 0 0 MC ACHENBACH 2.00 X X 0 0 0 ROBERT SEVERSON 1.00 X X 0 0 0 MIKE DAVIS 1.00 X 0 0 0 PAT MULHERN 1.00 X 0 0 0 SARA RYAN 1.00 X 0 0 0 JULIA NELSON 2.00 X X 0 0 0 DR MARK GRUNWALD 1.00 X 0 0 0 BILL SEXTON 1.00 X 0 0 0 ROY GEORGE 1.00 X 0 0 0 TOM FARRELL 1.00 X 0 0 0 DOUG DICKMAN 1.00 X 0 0 0 BARRY METEVIA 40.00 X 86100 0 15416 JACQUELINE CARLEY 40.00 X 80058 0 12699 MARY JO WOLCOTT 40.00 X 73160 0 16229 ALESHA ERDENBERGER 40.00 X 48338 0 15899 287656 0 60243 0 0 0 0 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH TX 72902 THERAPY SERVICES 781328 BP CONSTRUCTION SPECIALISTS LLC 2197 E BRUNSON STREET PRAIRIE DU CHIEN WI 53821 CONSTRUCTION 117541 2 12169 12169 NURSING HOME REVENUE 623000 8857668 8857668 ELDERLY HOUSING REVENU 623000 697509 697509 APARTMENT REVENUE 623990 136432 136432 9691609 15657 15657 1600 0 1600 1600 1600 MISCELLANEOUS REVENUE 623000 995 0 995 995 9722030 9691609 0 18252 349607 349607 4357843 4174925 182918 41000 38570 2430 1121752 1060136 61616 410413 368704 41709 309 309 12775 12775 223145 218037 5108 9646 9646 85741 85741 27275 27275 259436 258644 792 26608 12978 13630 389 389 562462 562462 68428 68428 SUPPLIES & PURCHASED SE 1344695 1344695 FOOD 423320 423320 BED ASSESSMENT 265200 265200 BAD DEBT EXPENSE 126885 126885 31971 11638 20333 9748900 8866583 882317 0 356669 115514 1761514 2056378 873984 1032526 77503 74918 39039 25716 14961668 3316160 11875249 11645508 5892 7315 14989850 14957875 695659 717279 583623 556898 1279282 1274177 X 13710568 13683698 13710568 13683698 14989850 14957875 -26870 0 X X 0 1 1 X 0 X 792 11843 5518 5565 12169 35887 7392661 7403163 8479390 9335955 9691609 42302778 995 995 7393453 7415006 8484908 9341520 9704773 42339660 0 0 0 42339660 222246 177035 18101 16708 17257 451347 222246 177035 18101 16708 17257 451347 17056 2774 49991 69821 7615699 7609097 8505783 9408219 9722030 42860828 0.98780 0.98750 0.01050 0.01080 X 0 0 0 0 0 0 0 0 1 210 210 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: COMMUNITY HEALTH SERVICES CORPORATION PAYS ANNUAL ASSOCIATION DUES TO WISCONSIN HEALTH CARE ASSOCIATION, INC. AND WISCONSIN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING. 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 12006820 1975607 10031213 2599940 1340553 1259387 11645508 9722030 9748900 -26870 -26870 9720810 0 9720810 1220 1220 9722030 9747680 0 9747680 1220 1220 9748900 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION 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 ORGANIZATION IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SIMILAR STATE OF WISCONSIN TAX LAWS. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE ORGANIZATION ASSESSES 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. THE ORGANIZATION'S POLICY IS TO RECOGNIZE INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. AS OF AND FOR THE YEARS ENDED JUNE 30, 2012 AND 2011, THERE WAS NO INCOME TAX EXPENSE, TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE ORGANIZATION IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2012 AND 2011. FEDERAL TAX RETURNS FOR THE YEARS ENDED JUNE 30, 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XII, LINE 4B - OTHER ADJUSTMENTS: LAUNDRY REVENUE NET AGAINST EXPENSES: $1,220 PART XIII, LINE 4B - OTHER ADJUSTMENTS: LAUNDRY REVENUE NET AGAINST EXPENSES: $1,220 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 990 IS DISTRUBUTED 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. 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 AUDIT THE BOARD OF DIRECTORS OF COMMUNITY HEALTH SERVICES CORPORATION REVIEWS THE AUDITED FINANCIAL STATEMENTS AT ITS BOARD MEETING AND IS RESPONSIBLE FOR THE OVER SIGHT 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 3878457 1719157 N/A PRAIRIE NURSING FACILITY LLC 700 S FREMONT ST PRAIRIE DU CHIEN WI 53821 201532236 NURSING HOME WI 4990232 1352178 N/A PRAIRIE MEMORIAL HOUSING LLC 720 S FREMONT ST PRAIRIE DU CHIEN WI 53821 391516772 ELDERLY HOUSING WI 835603 990747 N/A