2023-12-04T16:55:50-06:00 2023-06-30 430352985 KERBER ECK & BRAECKEL LLP 125 SOUTH 84TH STREET SUITE 100 MILWAUKEE WI 53214 990 2022-07-01 390826123 ST MARY'S HOME FOR THE AGED INC STMA 9206847171 1635 S 21ST ST MANITOWOC WI 542205652 LUKE SCHUBERT PRESIDENT/CEO 9206847171 2023-11-30 1 LUKE SCHUBERT 999009999 0 CHRISTIAN A SLAATS CPA P00963303 4144561099 2023-11-30 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z LUKE SCHUBERT 1635 S 21ST ST MANITOWOC WI 542205652 12839559 0 0928 X WWW.FELICIANVILLAGE.ORG X 1956 WI TO CONTINUE THE HEALING MINISTRY OF JESUS WITH PARTICULAR ATTENTION TO THE NEEDS OF THE POOR, AS WE PROVIDE SKILLED NURSING CARE AND HOUSING FOR SENIORS. 8 9 307 49 0 0 905432 178226 9916837 12105323 85923 94595 0 461415 10908192 12839559 0 0 0 0 6385952 8208574 0 0 149811 5268564 5905773 11654516 14114347 -746324 -1274788 29299302 27220334 23758065 22899799 5541237 4320535 X AS A FACILITY THAT PROVIDES SKILLED NURSING, REHABILITATION, ASSISTED LIVING, AND INDEPENDENT LIVING, ST. MARY'S CONTINUES THE HEALING MINISTRY OF JESUS BY PROVIDING COMPASSIONATE CARE THAT SUPPORTS THE VALUES OF RESPECT FOR HUMAN DIGNITY, COMPASSION, TRANSFORMATION, SOLIDARITY WITH THE POOR AND JUSTICE AND PEACE. 0 0 11997796 12105323 ST. MARY'S EMPLOYS OVER 300 PEOPLE IN DIRECT CARE AND SUPPORT RESPONSIBILITIES, REPRESENTING APPROXIMATELY 80,000 RESIDENT DAYS PER YEAR. CARE IS PROVIDED IN SKILLED NURSING, ASSISTED LIVING AND INDEPENDENT LIVING. SIGNIFICANT COMMUNITY SERVICE IS PROVIDED BY BOTH INDIVIDUALS SERVING ON BOARDS AND COMMITTEES AND BY THE ORGANIZATION SERVING AS A CLINICAL SITE FOR CURRICULUM REQUIREMENTS AND TRAINING FOR REGIONAL POST-SECONDARY EDUCATIONAL INSTITUTIONS IN ADDITION TO HOSTING VARIOUS OTHER EDUCATIONAL PROGRAMS.DURING 2022 - 2023, ST. MARY'S HOME PROVIDED IN EXCESS OF $900 THOUSAND IN UNREIMBURSED SERVICES FOR MEDICAID, FAMILY CARE, MEDICARE, AND MANAGED CARE RESIDENTS. IN ADDITION, HUNDREDS OF HOURS WERE DONATED TO AREA AGENCIES IN SUPPORT OF COMMUNITY ORGANIZATIONS AND EVENTS THAT BENEFIT RESIDENTS OF MANITOWOC COUNTY AND THE SURROUNDING AREAS. AMONG THE ORGANIZATIONS SUPPORTED THROUGH STAFF INVOLVEMENT ARE: ROTARY MANITOWOC, LAKESHORE TECHNICAL COLLEGE, FIRST PRESBYTERIAN CHURCH, ALZHEIMER'S ASSOCIATION, CHAMBER OF MANITOWOC COUNTY, MANITOWOC COUNTY YOUTH APPRENTICE PROGRAM, LEADING AGE- WISCONSIN, MANITOWOC COUNTY LEADERSHIP COMMITTEE, NATIONAL ASSOCIATION OF CATHOLIC CHAPLAINS, PETER'S PANTRY, HOMELESS HYGIENE DRIVE RECIPIENTS (HOPE HOUSE, INCOURAGE DOMESTIC VIOLENCE SHELTER, LAKESHORE CAP SUPPORTIVE HOUSING PROGRAM, LUTHERAN SOCIAL SERVICES RUNAWAY & YOUTH SERVICES, PAINTING PATHWAYS CLUBHOUSE, SOUTHFIELD NEIGHBORHOOD NETWORK LEARNING CENTER, TEE-BOX TRANSITIONAL SOBER LIVING, THE HAVEN OF MANITOWOC COUNTY, THE CROSSING) THE SALVATION ARMY, AND MANITOWOC COUNTY HISTORICAL SOCIETY. ST. MARY'S SERVED AS A CLINICAL SITE FOR LP AND AD NURSING STUDENTS ATTENDING LAKESHORE TECHNICAL COLLEGE, AND ONE CLINICAL PASTORAL EDUCATION CHAPLAIN STUDENT.FINALLY, ESTIMATED COSTS TO PROVIDE ALL THE ABOVE OPPORTUNITIES IS $23,054. 11997796 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 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 0 1 0 0 0 1 36 0 1 307 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X X SHANNON OTTEN 9206847171 1635 SOUTH 21ST STREET MANITOWOC WI 54220 DAVID WARD DIRECTOR 2.00 40.00 X 0 271807 38507 DR CAMERON GOETZ DIRECTOR 1.00 X 0 0 0 SISTER RAMONA DOMBROWSKI DIRECTOR 1.00 X 0 0 0 MICHAEL ETHERIDGE CHAIR 1.00 X 0 0 0 REV GERALD FOLEY EMERITUS 1.00 X 0 0 0 DENNIS SWETLIK DIRECTOR 1.00 X 0 0 0 THOMAS VEESER DIRECTOR 1.00 X 0 0 0 MARY MAURER VICE-CHAIR 1.00 X 0 0 0 MARCIA DONLON DIRECTOR 1.00 X 0 0 0 PASTOR MATT SAUER DIRECTOR 1.00 X 0 0 0 FRANK SOLTYS CEO/PRESIDENT 40.00 X 232180 0 24767 SHANNON OTTEN TREASURER 40.00 X 0 0 0 KATHERINE KOPENSKI VP OF OPERATIONS AND NHA 40.00 X 126580 0 0 358760 271807 63274 2 0 1 0 GREENFIELD REHAB AGENCY 3360 GATEWAY RD SUITE 100 BROOKFIELD WI 53045 PATIENT THERAPY 311576 SYSCO EASTERN WISCONSIN ONE SYSCO DRIVE JACKSON WI 530379226 FOOD SERVICE 296479 ALL AMERICAN HEALTHCARE SERVICES INC 494 BROAD ST SUITE 302 NEWARK NJ 07102 STAFFING AGENCY 139756 VANE HEY COMPANY INC N2093 COUNTY RD N APPLETON WI 549139229 LANDSCAPING 110020 GUNDERSON 41 MAIN STREET MENASHA WI 549523198 LAUNDRY 100752 5 9500 168726 178226 RESIDENT CARE SERVICES 623000 12105323 12105323 12105323 94595 94595 TRANSFERS FROM RELATED PARTY 900099 461415 461415 461415 12839559 12566738 0 94595 232180 232180 6640525 5778578 762885 99062 26754 22538 3826 390 927938 779560 135076 13302 381177 321103 54511 5563 10225 10225 47225 47225 381193 381193 109483 102634 2955 3894 324496 183248 138531 2717 44983 44983 871917 771941 90297 9679 21182 14807 5973 402 16099 214 15885 461416 442837 16780 1799 1619652 1583413 32731 3508 156595 140248 14764 1583 FOOD SERVICE 816597 811098 5459 40 HR/FINANCE SERVICES 626007 276788 341347 7872 RESIDENT CARE SERVICES 337060 325953 11107 BAD DEBTS 61643 61643 14114347 11997796 1966740 149811 6002377 4320798 39439 41760 45450 45450 242910 662511 158580 155699 48653995 27581463 22016646 21072532 793900 882084 0 39500 29299302 27220334 1412184 1596493 8204 8356 22337677 21255450 0 39500 23758065 22899799 X 4504579 3237790 1036658 1082745 5541237 4320535 29299302 27220334 -1274788 54086 0 X 0 1 X 1 0 X 147636 500152 3237386 905432 178226 4968832 14916229 14768422 11281741 9916837 12105323 62988552 15063865 15268574 14519127 10822269 12283549 67957384 0 0 0 67957384 11136 21707 41684 85923 94595 255045 11136 21707 41684 85923 94595 255045 15075001 15290281 14560811 10908192 12378144 68212429 0.99630 0.99700 0.00370 0.00300 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 833339 28440 62065 923844 946647 40453 -153761 833339 730536 27353 188758 946647 506038 216238 8260 730536 473652 15990 16396 506038 1.00000 1 0 593771 593771 44146008 24678364 19467644 3914216 2903099 1011117 21072532 LEASE LIABILITY 39500 39500 X 12893645 54086 54086 12839559 0 12839559 14114347 0 14114347 0 14114347 PART IV, LINE 2B: THE ORGANIZATION HOLDS CASH ON BEHALF OF CERTAIN RESIDENTS IN A SEPARATE CHECKING ACCOUNT, WHICH IS USED TO PAY FOR THE RESIDENTS' INCIDENTAL EXPENSES. PART V, LINE 4: THE HOME ESTABLISHED THE ST. MARY'S HOME ENDOWMENT FUND AS A PERMANENTLY RESTRICTED PERPETUAL ENDOWMENT FUND TO PROVIDE SUPPORT TO THE CHARITABLE MISSIONS OF ST. MARY'S AT FELICIAN VILLAGE, THE COURT AT FELICIAN VILLAGE, THE VILLA AT FELICIAN VILLAGE, AND THE GARDENS AT FELICIAN VILLAGE. THE ENDOWMENT CONSISTS OF INVESTMENTS ESTABLISHED TO FUND ITS MISSIONS AND IS DONOR-RESTRICTED. AS REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS, INCLUDING FUNDS DESIGNATED BY THE BOARD OF DIRECTORS TO FUNCTION AS ENDOWMENTS, ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS. PART X, LINE 2: ST. MARY'S HOME FOR THE AGED, INC., IS A NOT FOR PROFIT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM INCOME TAXES ON RELATED INCOME UNDER SECTION 501(A) OF THE CODE. THE HOME FOLLOWS THE ACCOUNTING STANDARDS FOR UNCERTAINTY IN INCOME TAXES. THESE STANDARDS REQUIRE ENTITIES TO DISCLOSE IN THEIR FINANCIAL STATEMENTS THE NATURE OF ANY UNCERTAINTIES IN THEIR TAX POSITION. AREAS THAT THE INTERNAL REVENUE SERVICE AND STATE TAX AUTHORITIES CONSIDER WHEN EXAMINING TAX AND INFORMATION RETURNS OF A TAX-EXEMPT ENTITY INCLUDE, BUT ARE NOT LIMITED TO, TAX-EXEMPT STATUS AND THE EXISTENCE AND AMOUNT OF UNRELATED BUSINESS INCOME. THE HOME DOES NOT BELIEVE THAT IT HAS ANY UNCERTAIN TAX POSITIONS WITH RESPECT TO THESE OR OTHER MATTERS, AND HAS NOT RECORDED ANY UNRECOGNIZED TAX BENEFITS OR LIABILITY FOR PENALTIES OR INTEREST. X X 0 0 0 0 0 0 0 0 0 DAVID WARD DIRECTOR 0 271807 0 0 0 0 0 0 0 38507 0 310314 0 0 FRANK SOLTYS CEO/PRESIDENT 232180 0 0 0 0 0 0 0 24767 0 256947 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER (FELICIAN SERVICES, INC.) HOLDS RESERVED POWERS IN ELECTING MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE CORPORATE MEMBER (FELICIAN SERVICES, INC.) HOLDS RESERVED POWERS REGARDING SPECIFIC DECISIONS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, FORM 990 WAS DISTRIBUTED VIA EMAIL TO EACH DIRECTOR FOR REVIEW AND COMMENT. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS OR TRUSTEES AND KEY EMPLOYEES MUST PROVIDE WRITTEN DISCLOSURE REGARDING INTERESTS THAT COULD GIVE RISE TO CONFLICT DURING THE ANNUAL BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 15 THE CORPORATE MEMBER (FELICIAN SERVICES, INC.) OBTAINED COMPARABILITY DATA IN DETERMINING COMPENSATION OF THE CEO AND TOP MANAGEMENT OFFICIALS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS WILL BE MADE AVAILABLE UPON WRITTEN REQUEST TO THE CONTACT LISTED IN PART VI, SECTION C, LINE 20. FELICIAN SERVICES INC 3800 W PETERSON AVENUE CHICAGO IL 60659 363685438 SOLE CORPORATE MEMBER OF NON-PROFIT RELIGIOUS SPONSORED ENTITIES IL 501(C)(3) LINE 1 CONGREGATION OF THE SISTERS OF ST FELIX OF CANTALICE 0 FELICIAN SISTERS OF NORTH AMERICA INC 871 MERCER ROAD BEAVER FALLS PA 05010 271282473 RELIGIOUS CONGREGATION PA 501(C)(3) LINE 1 N/A 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 0 SCHEDULE R, PART II, COLUMN A THE REPORTING ORGANIZATION AND ALL RELATED ORGANIZATIONS OF THE CONGREGATION OF THE SISTERS OF ST. FELIX OF CANTALICE ARE INCLUDED IN THE OFFICIAL CATHOLIC DIRECTORY.