2024-11-11T09:25:03-06:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 10401 W INNOVATION DR STE 300 WAUWATOSA WI 53226 990 2023-01-01 900506872 EDEN REHABILITATION SUITES AND GREENHOUSE HOMES INC EDEN 9202354653 3151 EDEN COURT OSHKOSH WI 54904 THERESA M BERTRAM PRESIDENT & CEO 9202325228 2024-11-08 1 0 KRISTEN DONLEVY P01670215 4144761880 2024-11-08 2023 2024-10-15 13:58:12Z THERESA M BERTRAM 3151 EDEN COURT OSHKOSH WI 54904 4648101 0 9386 X WWW.MIRAVIDALIVING.COM X 2009 WI NURSING AND REHABILITATION SERVICES TO AGING PERSONS. 9 9 66 9 0 0 357351 100000 4113377 4292658 444 0 4878 255443 4476050 4648101 0 0 0 0 3221665 3626371 0 0 0 2413344 2348856 5635009 5975227 -1158959 -1327126 7195976 7062303 13586922 14780375 -6390946 -7718072 EDEN REHABILITATION SUITES AND GREENHOUSE HOMES. INC. IS PART OF A FAMILY OF HEALTHCARE AND RESIDENTIAL SERVICE ORGANIZATIONS PROVIDING QUALITY CARE AND LIFE ENRICHING OPPORTUNITIES TO THE AGING AND THOSE IN NEED IN A CARING, CHRISTIAN ENVIRONMENT. 0 0 5110704 0 4292658 EDEN REHABILITATION SUITES AND GREEN HOUSE HOMES, INC. OPERATES A 50-BED NURSING FACILITY PROVIDING SKILLED AND INTERMEDIATE NURSING CARE FOR THE AGED AND DISABLED OF OSHKOSH AND THE SURROUNDING AREA. THE HOME CONSISTS OF ONE 30 BED REHAB BUILDING AND TWO 10 BED GREEN HOUSE HOMES. 5110704 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 1 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 1 0 0 0 1 8 0 1 66 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X KIM MAKI 9202325238 225 N EAGLE STREET OSHKOSH WI 54902 THERESA BERTRAM PRESIDENT & CEO 4.00 34.00 X X 0 393735 0 MARK BEECHER CHAIR 0.20 1.40 X X 0 0 0 NATE OLSON VICE CHAIR 0.20 1.40 X X 0 0 0 JAMIE BONELL SECRETARY 0.20 1.40 X X 0 0 0 STEW RIECKMAN BOARD MEMBER 0.20 1.40 X 0 0 0 MARK BOETTCHER BOARD MEMBER 0.20 1.40 X 0 0 0 DIANE LANGDON BOARD MEMBER 0.20 1.40 X 0 0 0 JASON LOWE BOARD MEMBER 0.20 1.40 X 0 0 0 DR PAULA MCNIEL BOARD MEMBER 0.20 1.40 X 0 0 0 JIM STAPEL BOARD MEMBER 0.20 1.40 X 0 0 0 0 393735 0 0 0 1 0 KELSTAR PARTNERSHIP N8874 CHURCH ST FOREST JUNCTION WI 54123 STAFFING SERVICES 591516 SHIFTKEY PO BOX 735913 DALLAS TX 753735913 STAFFING SERVICES 435886 FUNCTIONAL PATHWAYS LLC 10133 SHERRILL BLVD STE 200 KNOXVILLE TN 379323347 THERAPY SERVICES 272523 PRN HEALTHCARE 1101 E SOUTH RIVER ST APPLETON WI 54915 STAFFING SERVICES 114440 MARTIN BROS DISTRIBUTING CO INC PO BOX 69 CEDAR FALLS IA 50613 FOOD SERVICES 100954 5 100000 100000 RESIDENT REVENUE 623990 4292658 4292658 4292658 MISCELLANEOUS REVENUE 900099 252631 252631 TRANSPORTATION REVENUE 900099 2512 2512 VACCINE REVENUE 900099 300 300 255443 4648101 4292658 0 255443 3353332 2779837 573495 40399 33532 6867 125164 103887 21277 107476 89206 18270 258528 258528 4426 4426 43655 43655 2100 2100 364592 360914 3678 3584 3584 58256 16107 42149 13162 13162 327156 327156 79530 79080 450 332508 332508 305912 305912 42368 42368 MEDICAL SUPPLIES 263436 263436 BAD DEBT 118000 118000 BED ASSESSMENT 102000 102000 MISCELLANEOUS EXPENSES 29373 13863 15510 270 270 5975227 5110704 864523 0 151500 108918 369517 537100 22301 14548 22205 24162 11295265 5504575 6048945 5790690 66633 66633 514875 520252 7195976 7062303 405658 360886 7250323 6989777 1472 1965 5929469 7427747 13586922 14780375 X -6390946 -7718072 -6390946 -7718072 7195976 7062303 -1327126 0 X 0 1 X 1 1 1 X 19000 822579 1026568 357351 100000 2325498 5657103 4239393 3653332 4113377 4292658 21955863 5676103 5061972 4679900 4470728 4392658 24281361 0 3551769 2690573 2246534 2837702 3084152 14410730 3551769 2690573 2246534 2837702 3084152 14410730 9870631 271 225 1 444 941 271 225 1 444 941 13717 15902 9428 4878 255443 299368 5690091 5078099 4689329 4476050 4648101 24581670 0.40150 0.41830 0.00000 0.00020 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MEAL REVENUE - 2019 AMOUNT: $ 3,718. 2020 AMOUNT: $ 661. 2021 AMOUNT: $ -537. 2022 AMOUNT: $ 90. MISCELLANEOUS REVENUE - 2019 AMOUNT: $ 9,999. 2020 AMOUNT: $ 4,999. 2021 AMOUNT: $ 8,777. 2022 AMOUNT: $ 4,788. 2023 AMOUNT: $ 252,931. COVID-19 ADMIN TELE-HEALTH REIMBURSEMENT - 2020 AMOUNT: $ 10,242. 2021 AMOUNT: $ 1,188. RESIDENT TRANSPORTATION REVENUE - 2023 AMOUNT: $ 2,512. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 468688 468688 7095994 2308025 4787969 770780 655581 115199 2959803 2540969 418834 5790690 DEBT SERVICE RESERVE 311979 RESIDENT TRUST 3033 BOND FUNDS 205240 520252 DUE TO AFFILIATES 7427747 7427747 X PART IV, LINE 2B: RESIDENT'S CUSTODIAL ACCOUNTS CONSIST OF AMOUNTS ON DEPOSIT WITH EDEN REHABILITATION SUITES AND GREEN HOUSE HOMES, INC. BY RESIDENTS FOR SAFEKEEPING. THESE FUNDS CAN BE WITHDRAWN AT ANY TIME BY RESIDENTS. PART X, LINE 2: THE ORGANIZATION FOLLOWS THE PROVISIONS OF THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THE INCOME TAX STANDARD HAD NO IMPACT ON THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATIONS FILES INFORMATIONAL RETURNS AS A TAX-EXEMPT ORGANIZATION. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. 0 0 0 0 0 0 0 0 0 THERESA BERTRAM PRESIDENT & CEO 0 393735 0 0 0 0 0 0 0 0 0 393735 0 0 PART I, LINE 3 THE COMPENSATION OF THE PRESIDENT & CEO IS DETERMINED BY THE ORGANIZATION'S SOLE MEMBER, MIRAVIDA LIVING INC. THE FOLLOWING METHODS WERE USED BY MIRAVIDA LIVING INC TO ESTABLISH THE PRESIDENT & CEO'S COMPENSATION: 1. COMPENSATION SURVEY OR STUDY 2. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. A HOUSING AUTHORITY OF THE COUNTY OF WINNEBAGO WISCONSIN 391252334 974611AK1 2015-06-23 9115000 FOR CONSTRUCTION OF EDEN REHABILITATION SUITES AND GREENHOUSE HOMES, INC. 0 0 0 A 2074367 9115000 307000 182300 8625700 2015 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD OF DIRECTORS PLUS TWO OTHER MEMBERS OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL BE RESPONSIBLE FOR THE AGENDA FOR THE BOARD AND VOTING MEMBERSHIP MEETINGS. THIS COMMITTEE SHALL KEEP ITSELF INFORMED OF THE ENTIRE OPERATION OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS, AND SHALL EXECUTE SUCH ACTIONS AS MAY BE ASSIGNED TO IT BY THE BOARD. THE COMMITTEE SHALL ALSO CONCERN ITSELF WITH MATTERS NOT ASSIGNED TO OTHER COMMITTEES. FORM 990, PART VI, SECTION A, LINE 6 MIRAVIDA LIVING, INC. IS THE SOLE MEMBER OF EDEN REHABILITATION SUITES AND GREENHOUSE HOMES, INC. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS OF EDEN REHABILITATION SUITES AND GREENHOUSE HOMES, INC. ARE ELECTED BY THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC. FORM 990, PART VI, SECTION A, LINE 7B MAJOR STANDARD OPERATING PROCEDURES, MAJOR POLICIES, AND PROGRAMS OF EDEN REHABILITATION SUITES AND GREENHOUSE HOMES, INC. ARE SUBMITTED TO THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC. FOR APPROVAL AND IMPLEMENTATION. AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS REQUIRE THE APPROVAL OF THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC. FORM 990, PART VI, SECTION B, LINE 11B BEFORE IT WAS FILED, THE FORM 990 WAS REVIEWED BY THE CEO, THEN DISTRIBUTED TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE CORPORATE SECRETARY DISTRIBUTES A CONFLICT OF INTEREST FORM TO EACH MEMBER OF THE BOARD OF DIRECTORS AND VARIOUS COMMITTEE MEMBERS NOT ON THE BOARD THAT REQUIRES EACH TO IDENTIFY POTENTIAL CONFLICTS OR OTHER RELATED PARTY INTERESTS. THE REPORTS ARE REVIEWED BY THE SECRETARY AND CEO AND ANY CONFLICTS ARE BROUGHT TO THE BOARD'S ATTENTION. A MEMBER OF THE BOARD WHO HAS A CONFLICT OF INTEREST MAY NOT VOTE ON ANY SUCH ISSUE BEFORE THE BOARD. ANY QUESTION OF WHETHER THERE IS A CONFLICT IS RESOLVED BY THE BOARD OF DIRECTORS. IF THE BOARD OF DIRECTORS DETERMINES THAT A DIRECTOR HAS COMMITTED A SUBSTANTIAL VIOLATION OF THE CONFLICT OF INTEREST POLICY, THE INDIVIDUAL IS REMOVED FROM THE OFFICE OF DIRECTOR. IN ADDITION, ALL MANAGEMENT AND SUPERVISORY EMPLOYEES ARE INFORMED OF THE ORGANIZATIONS POLICY REGARDING RELATED PARTY TRANSACTIONS AND CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. MIRAVIDA LIVING INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391032234 MANAGEMENT SERVICES WI 501(C)(3) LINE 10 0 BETHEL HOME INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391209707 SKILLED NURSING FACILITY WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 CARMEL RESIDENCE INC 220 NORTH WESTFIELD STREET OSHKOSH WI 54902 391448325 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 GABRIEL'S VILLA INC 215 NORTH WESTFIELD STREET OSHKOSH WI 54902 391857036 SENIOR HOUSING WI 501(C)(3) LINE 12A, I MIRAVIDA LIVING INC 0 SIMEANNA APARTMENTS INC 155 N EAGLE ST OSHKSOH WI 54902 237148097 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA SOUTH INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391238670 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA III INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391270056 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 MIRAVIDA LIVING FOUNDATION INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 010938793 FUNDRAISING WI 501(C)(3) LINE 12A, I MIRAVIDA LIVING INC 0 0 0 1 1 1 0 0 0 0 1 1 0 1 1 1 1 1 0 0