2024-08-13T08:21:37-05:00 2023-09-30 390758449 WIPFLI LLP 170 N RADNOR-CHESTER RD SUITE 200 RADNOR PA 19087 990 2022-10-01 390829541 SHADY LANE INC SHAD 9206828254 1235 SOUTH 24TH STREET MANITOWOC WI 542205516 KASANDRA PAIDER CFO 9206828254 2024-08-12 1 0 SOLOMON MARDAKHAEV P01806552 6105653930 2024-08-05 2022 2024-08-08 14:25:15Z KASANDRA PAIDER 1235 SOUTH 24TH STREET MANITOWOC WI 542205516 10406285 0 X WWW.SHADYLANEINC.COM X 1950 WI NURSING CARE FOR THE AGED AND DISABLED. 13 13 253 20 0 0 412501 14421 8201742 9197722 35204 72550 15025 2312 8664472 9287005 0 0 0 0 6003262 6216041 0 0 0 4455178 4675103 10458440 10891144 -1793968 -1604139 13650522 12135844 6502456 6412322 7148066 5723522 X SHADY LANE STRIVES TO PROVIDE OLDER ADULTS IN MANITOWOC COUNTY THE HIGHEST QUALITY RESIDENTIAL CARE AT A REASONABLE COST. RESIDENTS OF SHADY LANE CAN EXPECT TO ENJOY A HOME-LIKE SETTING WITH A SUPPORTIVE ATMOSPHERE THAT RESPECTS INDIVIDUALITY, PROMOTES PHYSICAL AND EMOTIONAL WELL BEING, AND ENCOURAGES INDEPENDENCE. 0 0 5814991 0 5017262 SKILLED NURSING SERVICES ARE OFFERED TO THE SENIOR POPULATION. THESE ARE THE HIGHER ACUITY POPULATION NEEDING THE MOST INTENSE SKILLED NURSING SERVICES. RESIDENTS TREATED CAN INCLUDE THE PRIVATE PAY RESIDENTS, AND THE RESIDENTS ON GOVERNMENT FUNDING (MEDICARE AND MEDICAID). NUMBER OF RESIDENTS TREATED IN PLAN YEAR WERE 144. 3756308 0 4054962 ASSISTED LIVING SERVICES ARE OFFERED TO THE LIGHTER CARE ASSISTED LIVING POPULATION. THESE RESIDENTS CAN MAINTAIN AN AMOUNT OF INDEPENDENCE WHILE STILL RECEIVING THE NECESSARY NURSING SERVICE TO MAINTAIN A QUALITY OF LIFE. RESIDENTS IN THE ASSISTED LIVING CAN INCLUDE THE PRIVATE PAY RESIDENTS AND RESIDENTS RECEIVING GOVERNMENT FUNDING. NUMBER OF RESIDENTS TREATED IN PLAN YEAR WERE 138. 9571299 1 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 23 0 253 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X KASANDRA PAIDER 9206828254 1235 S 24TH STREET MANITOWOC WI 54220 SANDY HARDRATH BOARD CHAIR 0.50 X X 0 0 0 JEREMY SEHLOFF BOARD VICE CHAIR 0.50 X X 0 0 0 DAVID LESS BOARD SECRETARY 0.50 X X 0 0 0 KAY AVCI BOARD MEMBER 0.50 X 0 0 0 JUDY CAREY BOARD MEMBER (THRU DEC 2023) 0.50 X 0 0 0 AMY FRICKE-WEIGEL BOARD MEMBER 0.50 X 0 0 0 HEATHER GARCIA BOARD MEMBER 0.50 X 0 0 0 DAYNA GOETZ BOARD MEMBER 0.50 X 0 0 0 MARY GOVIER BOARD MEMBER 0.50 X 0 0 0 STANLEY JOHNSON BOARD MEMBER (THRU DEC 2023) 0.50 X 0 0 0 NANCY MUSIAL BOARD MEMBER (THRU DEC 2023) 0.50 X 0 0 0 JODY NEILSON BOARD MEMBER 0.50 X 0 0 0 MATTHEW NEU BOARD MEMBER 0.50 X 0 0 0 MONICA NICHTER BOARD MEMBER 0.50 X 0 0 0 KAREN O'LEARY BOARD MEMBER 0.50 X 0 0 0 TINA PRIGGE BOARD MEMBER (THRU DEC 2023) 0.50 X 0 0 0 KATHERINE REYNOLDS BOARD MEMBER 0.50 X 0 0 0 DENNIS TIENOR BOARD MEMBER (THRU DEC 2023) 0.50 X 0 0 0 TODD MEERDINK CEO 40.00 X 155514 0 35332 KASANDRA PAIDER CFO 40.00 X 112152 0 11614 DEANNE WEIER DIRECTOR OF NURSING 40.00 X 101867 0 34394 YUMIKO RAPISARDA-DOERFLER NURSE 40.00 X 110681 0 10952 480214 0 92292 4 0 1 0 HOMECARE HEALTH SERVICES AND HOSPICE 1004 WASHINGTON ST MANITOWOC WI 54220 THERAPY SERVICES 486804 PRN HEALTHCARE 1101 E SOUTH RIVER ST APPLETON WI 54915 HEALTHCARE SERVICES 165647 2 14421 14421 SKILLED NURSING FACILITY 623000 5017262 5017262 ASSISTED LIVING FACILITY 623000 4054962 4054962 OTHER 623000 112005 112005 BEAUTY & BARBER SHOP 623000 7153 7153 CAFETERIA REVENUES 623000 6340 6340 9197722 11887 11887 2312 0 2312 2312 2312 1179943 1119280 60663 60663 60663 9287005 9072224 0 200360 X 314531 314531 5083393 4700618 382775 49777 49777 370759 360067 10692 397581 354969 42612 2795 2795 55268 55268 4838 4838 1307513 1266234 41279 124443 124443 812008 650193 161815 353388 321857 31531 1022 590 432 191670 173626 18044 974655 880374 94281 204520 181007 23513 MEDICAL SUPPLIES 304755 304755 REPAIRS AND MAINTENANCE 104093 104093 BED ASSESSMENT 102000 102000 BAD DEBT EXPENSE 91877 91877 40258 29262 10996 10891144 9571299 1319845 0 999147 112180 131470 120892 381127 959172 5456 661 100190 83844 23870961 14972167 9790298 8898794 868987 384549 1373847 1575752 13650522 12135844 1013581 1058179 5483620 5354143 5255 0 6502456 6412322 X 7123066 5698522 25000 25000 7148066 5723522 13650522 12135844 X -1604139 -22310 201905 X X 0 1 X 1 0 X 13298 1562565 794809 412501 14422 2797595 9568226 8903544 8628230 8074131 9072224 44246355 154036 154615 106129 127611 125498 667889 9735560 10620724 9529168 8614243 9212144 47711839 0 25688 20235 64274 309004 404197 823398 25688 20235 64274 309004 404197 823398 46888441 57383 42432 36702 28356 14199 179072 57383 42432 36702 28356 14199 179072 9792943 10663156 9565870 8642599 9226343 47890911 0.97910 0.98570 0.00370 0.00500 X 0 1 X 25000 25000 25000 25000 25000 25000 25000 25000 25000 25000 1.00000 0 0 216216 216216 20904386 13314608 7589778 2750359 1657559 1092800 8898794 INVESTMENT IN LAKESHORE COMMUNITY FOUNDATION 1575752 1575752 9461762 -22310 201905 179595 9282167 4838 4838 9287005 10886306 0 10886306 4838 4838 10891144 PART IV, LINE 2B: RESIDENTS' FUNDS HELD IN TRUST CONSIST OF AMOUNTS ON DEPOSIT WITH THE ORGANIZATION BY RESIDENTS FOR SAFEKEEPING. THESE FUNDS CAN BE WITHDRAWN AT ANY TIME BY THE RESIDENTS. PART V, LINE 4: PERMANENTLY RESTRICTED NET ASSETS AT SEPTEMBER 30, 2023 REPRESENT A DONOR-RESTRICTED ENDOWMENT FUND. THE INCOME FROM THE ENDOWMENT FUND IS EXPENDABLE TO SUPPORT INCIDENTAL EXPENSES OF RESIDENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN LAKESHORE COMMUNITY FOUNDATION 201,905. X X X 0 0 0 0 0 0 0 1 0 TODD MEERDINK CEO 146514 0 9000 0 0 0 4914 0 30418 0 190846 0 0 0 PART I, LINE 7 SCHEDULE J, PART II, COLUMN (B)(II) REPORTS DISCRETIONARY INCENTIVE AMOUNTS THAT WERE APPROVED BY THE BOARD BASED UPON PERFORMANCE. A WISCONSIN HEALTH AND EDUCATION FINANCE AUTHORITY SERIES 2016 391337855 2016-12-23 6000000 0 0 0 A 131654 6000000 64525 5935475 2016 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE ORGANIZATIONS' BOARD OF DIRECTORS EXECUTIVE COMMITTEE BEFORE IT WAS FILED. THE FINAL FORM 990 IS MADE AVAILABLE TO ALL BOARD MEMBERS. THE EXECUTIVE COMMITTEE DESIGNATES THE DETAIL REVIEW OF THE FORM 990 TO MANAGEMENT, BUT HAS FINAL APPROVAL OF THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS AUTHORIZES THE OFFICERS OF THE ORGANIZATION TO PERIODICALLY, BUT NOT LESS THAN ANNUALLY, SURVEY THE BOARD MEMBERS REGARDING ANY POTENTIAL CONFLICTS, TO MAINTAIN SUCH INFORMATION AND REPORT BACK TO THE BOARD REGARDING ANY POTENTIAL CONFLICTS OF INTEREST. BOARD MEMBERS HAVE THE DUTY TO FULLY DISCLOSE TO THE BOARD, PRIOR TO DELIBERATIONS, THE NATURE AND EXTENT OF ANY INTEREST IN ANY TRANSACTION BEING CONSIDERED. AFTER THE DISCLOSURE IS MADE AND THE INTERESTED PARTY ANSWERS ALL APPROPRIATE QUESTIONS, HE SHALL DEPART FROM THE PORTION OF THE MEETING IN WHICH THE TRANSACTION IS BEING CONSIDERED AND SHALL NOT PARTICIPATE IN FURTHER DISCUSSION OF OR VOTE ON THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION FOR THE OFFICERS AND OTHER KEY EMPLOYEES OF THE ORGANIZATION INCLUDE: 1) REVIEW AND APPROVAL BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS (THOSE WITHOUT CONFLICT); 2) USE OF DATA AS TO COMPARABLE COMPENSATION; AND 3) CONTEMPORANEOUS DOCUMENTATION AND RECORD KEEPING. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION BELIEVES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE THE PROPERTY OF THE ORGANIZATION AND DOES NOT MAKE THEM AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G MEDICAL CONSULTANTS: PROGRAM SERVICE EXPENSES 69,439. MANAGEMENT AND GENERAL EXPENSES 4,400. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 73,839. MAINTENANCE CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 60,100. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 60,100. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 732,315. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 732,315. THERAPY CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 404,380. MANAGEMENT AND GENERAL EXPENSES 36,879. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 441,259. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN LAKESHORE COMMUNITY FOUNDATION 201,905. FORM 990, PART XII, LINE 2C: FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF THE AUDIT FIRM. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.