QUALITY SOLUTIONS FOR LONG TERM CARE Main # 1-608-326-0434 106 S Beaumont Road Toll Free Phone # 1-844-534-7225 Prairie du Chien, WI 53821 Toll Free Fax # 1-844-634-7225 Website Portal: www.lkfiscal.com Contacts for Employers & Employees Jessica Esser Fiscal Payroll Specialist for Care WI Ph: 608-326-0434 x206 Email: Jessica.esser@loriknappcompanies.com Contact Jessica with any payroll and timesheet questions, or payroll problems. Rita Severson Fiscal Payroll Specialist for ContinuUs, Unified Community Services, CCCW, ContinuUs North, Richland Co H.H, and WWC Ph: 608-326-0434 x250 Email: rita.severson@loriknappcompanies.com Contact Rita with any payroll and timesheet questions, or payroll problems. Natalie Freymiller Fiscal Account Manager for Care WI & CCCW Ph: 608-326-0434 x225 Email: natalie.freymiller@loriknappcompanies.com Contact Natalie with any member or employee referral or set-up questions. Mary Tempus Fiscal Account Manager Ph: 608-326-0434 x265 Email: mary.tempus@loriknappcompanies.com Contact Mary with any member or employee referral or set-up questions. Tina Hullermann Fiscal Payroll Specialist for Care WI Ph: 608-326-0434 x230 Email: tina.hullermann@loriknappcompanies.com Contact Tina with any payroll and timesheet questions, or payroll problems. Hilda Hendren Fiscal Payroll Specialist for Lakeland Care District Ph: 608-326-0434 x264 Email: hilda.hendren@loriknappcompanies.com Contact Hilda with any payroll and timesheet questions, or payroll problems. Jen Eulgem Fiscal Account Manager for ContinuUs, WWC, Lakeland Care District, and RCHHS Ph: 608-326-0434 x231 Email: jennifer.eulgem@loriknappcompanies.com Contact Jen with any member or employee referral or set-up questions. Linda Cliff Office Support Manager Ph: 608-326-0434 Email: linda.cliff@loriknappcompanies.com Front desk contact. Contact your employer for any employment related questions
Fiscal Agent Member/Employer Packet check list Introduction of Lori Knapp Companies Services, resources, and contacts Fiscal agent authorization and release of information complete, sign, and date Allows us to apply for a Federal ID on your behalf and gives us access to forms and information if you have had a previous fiscal agent IRS form SS-4 - complete, sign, and date Allows us to apply for an Employer ID# for tax administration and reporting purposes IRS form 2678 - complete, sign, and date Authorizes Lori Knapp Richland, Inc. as fiscal agent to act as the member s agent for tax reporting, depositing, and paying. Be sure to obtain a copy of guardianship paperwork if applicable. Pay Schedule Information This form explains when timesheets are due and when the hired-worker is paid. o Payroll is run twice a month o Pay schedule details out the last day of the pay period, the date the timesheet is due in the Prairie du Chien office, and the date the worker will be paid. Civil rights Handout Employer handbook Fraud and Abuse Fiscal Employer Agent Member/Employer Agreement and Responsibilities Supportive Home Care Addendum (ContinuUs only) Other Important Topics to discuss: They are the employer Discuss our website resources at www.lkfiscal.com o Provide handout and explanation of the Fiscal website Discuss the importance of having a backup plan in case their worker is unavailable Any questions can be directed to our Fiscal agent team: o Please see Contact Page Paperwork disbursement: Member/employer keeps: Resources and contact page Pay Schedule Information Civil Rights handout Fraud and abuse handout Website handout *All other paperwork is brought back to the office for processing
Fiscal Employer Agent Employer Agreement This agreement is between Lori Knapp Richland, Inc. as Fiscal agent and me/employer,. I am the Member The guardian I have chosen Lori Knapp Richland, Inc. as Fiscal agent. This agreement helps everyone understand their roles and responsibilities related to the Fiscal Employer Agent program. Roles and responsibilities of the member/employer (and/or guardian): 1. Complete all forms required to get the Fiscal agent program set up 2. Follow all Federal and State regulations regarding employment processes, equal employment opportunities, non-discrimination, and all other laws to ensure that fair and consistent practices are being used. 3. I understand that the member (person receiving services) is the employer of record and is responsible for: Screening, hiring, training, and supervision of the employees The actions of the employees whom I choose to hire My actions towards the employees I choose to hire 4. I accept that Lori Knapp Richland, Inc. as Fiscal agent is not the employer. They assist with administrative tasks and perform payroll services for my employees. 5. Require that my employees turn in accurate timesheets on a timely basis. I will review the timesheets for accuracy before signing off. I understand what Fraud and Abuse is and will not sign timesheets that: list hours not worked list any other fraudulent information that result in over-payments 6. Stay within the guidelines of what is authorized for hours worked and tasks required not using more hours than what my care manager has approved 7. Provide my employee with good training so my needs and outcomes are met 8. Make the payment of any wages and expenses that exceed the amount authorized in the member s budget and/or all overtime payments 9. Issues or concerns on my safety, health, or well-being (to include abuse, neglect and misappropriation of funds) should be reported immediately to my care management team. 10. Issues or concerns with my employee timesheets should be directed to my Fiscal agent provider. 11. Inform Lori Knapp Inc. of status changes with my employees (i.e. new employees, employees that are no longer there, etc) 12. If my employee has a work-related injury, make sure my employee reports this within 24 hours to Lori Knapp at 1-844-534-7225 13. Inform Lori Knapp Inc of any employees who do not work for 90 days or more.
Roles and responsibilities of Lori Knapp Richland Inc. as Fiscal Agent: 1. Provide and coordinate all paperwork necessary to get the member and their employees set up in the Fiscal Agent program. 2. Set up Federal Identification Number, workers compensation, and all other paperwork required for the Fiscal Agent program 3. Pay wages to the member s employees according to the approved timesheets 4. File monthly tax reports and make appropriate tax payment to include: state income tax, federal income tax deposits, and tax levies, garnishments, and court ordered deductions. 5. File quarterly tax reports and make appropriate tax payments to include: form 941 Employer Tax Report, Schedule R, SUTA Tax-Form UCT 101, and state wage reporting. 6. File annual tax reports and make appropriate tax payments to include: Federal W-2 and W-3, FUTA 940, Schedule R, state of Wisconsin WT-7, and check issuance of refundable FICA tax to employees under the annual threshold. 7. Maintain payroll records for every employer and provider in accordance with state and federal laws and regulations. 8. Submit claims to the funding agency on behalf of the member. 9. Inform and communicate with the member and/or care manager when hours exceed authorized units 10. Inform the member of our Fiscal agent portal a tool they can use to assist them with trainings and other employer-related functions 11. Provide excellent customer service and assistance so the member can achieve great outcomes! Conclusion: The member is the employer of record and is responsible for all personnel practices and their employees. The relationship of Lori Knapp Richland, Inc. as Fiscal agent to the member is that of performing limited administrative tasks and performing payroll services for the member and their employees. Neither party is an employee or representative of the other party. The member/employer will hold Lori Knapp Richland, Inc. as Fiscal Agent harmless of any lawsuits or claims resulting in their (the member s/employer s) actions or the actions of their (the member s the member s/employer s) employees. Any damages or costs incurred, including the costs of corporate counsel, will be paid for by the member. I understand and accept this agreement Lori Knapp Richland, Inc. as Fiscal Agent (Signature) Date Fiscal Agent Member/Employer or Guardian (Signature) Date
LORI KNAPP COMPANIES 1-844-534-7225: Fiscal Office info@loriknappcompanies.com Time Reports & Pay Schedule Information (for the Self-Directed Supports/Fiscal Agent Programs) What s a Time Report? A Time Report is a payroll time sheet submitted to the Lori Knapp Companies on a timely basis by providers/employees of the Self-Directed Supports/Fiscal Agent Programs. Pay Schedule After you complete work on the following day Ensure that your Time Report(s) are at the Prairie du Chien Office by So that you are PAID on the following date via Direct Deposit: (Pay Period) (Time Report Due Date) (Pay Date) 12/01/2015 to 12/15/2015 12/22/2015 12/30/2015 12/16/2015 to 12/31/2015 01/07/2016 01/15/2016 01/01/2016 to 01/15/2016 01/22/2016 01/29/2016 01/16/2016 to 01/31/2016 *02/06/2016* 02/12/2016 02/01/2016 to 02/15/2016 *02/20/2016* 02/29/2016 02/16/2016 to 02/29/2016 *03/05/2016* 03/15/2016 03/01/2016 to 03/15/2016 03/22/2016 03/30/2016 03/16/2016 to 03/31/2016 04/07/2016 04/15/2016 04/01/2016 to 04/15/2016 04/22/2016 04/29/2016 04/16/2016 to 04/30/2016 *05/07/2016* 05/13/2016 05/01/2016 to 05/15/2016 *05/21/2016* 05/31/2016 05/16/2016 to 05/31/2016 06/07/2016 06/15/2016 06/01/2016 to 06/15/2016 06/22/2016 06/30/2016 06/16/2016 to 06/30/2016 07/07/2016 07/15/2016 07/01/2016 to 07/15/2016 07/22/2016 07/29/2016 07/16/2016 to 07/31/2016 *08/06/2016* 08/15/2016 08/01/2016 to 08/15/2016 *08/20/2016* 08/30/2016 08/16/2016 to 08/31/2016 09/07/2016 09/15/2016 09/01/2016 to 09/15/2016 09/22/2016 09/30/2016 09/16/2016 to 09/30/2016 10/07/2016 10/14/2016 10/01/2016 to 10/15/2016 *10/22/2016* 10/28/2016 10/16/2016 to 10/31/2016 *11/05/2016* 11/15/2016 11/01/2016 to 11/15/2016 11/22/2016 11/30/2016 11/16/2016 to 11/30/2016 12/07/2016 12/15/2016 12/01/2016 to 12/15/2016 12/22/2016 12/30/2016 SO, IF YOU SUBMIT YOUR TIME REPORT between the 1 st and the 15 th of a month, payment will be the 30 th day of the same month between the 16 th and the 31 st of a month, payment will be the 15 th day of the following (next) month * When the submission period falls on a weekend please make sure to have timesheets in the LKiChoice, Prairie du Chien office by the Friday before. Forms & Submission Late Time Reports Forms are available on our Fiscal Agent Services website: www.lkfiscal.com Faxing your Time Report: (844) 634-7225 Mailing your Time Report: 106 S Beaumont Road, Prairie du Chien, WI 53821 Emailing your Time Report: payroll@loriknappcompanies.com Time Reports received after the date indicated in the middle column above titled Time Report Due Date will be processed in the next pay period. No Exceptions. Questions Call 1-844-534-7225 Document Effective: 12-31-2010 Document Updated: November 11, 2015 12042008 FISCAL AGENT PROGRAM Time Reports Pay Schedule Information Lori Knapp Companies Time Reports & Pay Schedule Information 2014 Page 1 of 1