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QUALITY SOLUTIONS FOR LONG TERM CARE
Contact your employer for any employment related questions
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: [email protected]
Contact Jessica with any payroll and
timesheet questions, or payroll problems.
Tina Hullermann Fiscal Payroll Specialist for Care WI
Ph: 608-326-0434 x230
Email: [email protected]
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: [email protected]
Contact Rita with any payroll and timesheet
questions, or payroll problems.
Hilda Hendren Fiscal Payroll Specialist for
Lakeland Care District
Ph: 608-326-0434 x264
Email: [email protected]
Contact Hilda with any payroll and timesheet
questions, or payroll problems.
Natalie Freymiller Fiscal Account Manager for Care WI & CCCW
Ph: 608-326-0434 x225
Email: [email protected]
Contact Natalie with any member or
employee referral or set-up questions.
Jen Eulgem Fiscal Account Manager for ContinuUs, WWC,
Lakeland Care District, and RCHHS
Ph: 608-326-0434 x231
Email: [email protected]
Contact Jen with any member or employee
referral or set-up questions.
Mary Tempus Fiscal Account Manager
Ph: 608-326-0434 x265
Email: [email protected]
Contact Mary with any member or employee
referral or set-up questions.
Linda Cliff Office Support Manager
Ph: 608-326-0434
Email: [email protected]
Front desk contact.
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
_________________________________________ Date__________________ (Signature)
Fiscal Agent Member/Employer or Guardian
__________________________________________ Date__________________ (Signature)
Lori Knapp Companies Time Reports & Pay Schedule Information © 2014 Page 1 of 1
LORI KNAPP COMPANIES 1-844-534-7225: Fiscal Office
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 …
(Pay Period)
Ensure that your Time
Report(s) are at the
Prairie du Chien Office by …
(Time Report Due Date)
So that you are PAID
on the following date
via Direct Deposit:
(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 1st and the 15th of a month, payment will be the 30th day of the same month
� between the 16th and the 31st of a month, payment will be the 15th 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
• 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: [email protected]
Late Time
Reports • 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
