SHEBOYGAN SENIOR COMMUNITY INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
SHEBOYGAN SENIOR COMMUNITY INC (EIN 39-6069188)
Tax period
2021-07-01 to 2022-06-30
Filed
2023-03-28
IRS object ID
202310879349301141
Schema version
2021v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2023-03-28T16:50:30-05:00ReturnTs
Tax Period End2022-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line110401 W INNOVATION DR STE 300AddressLine1Txt
CityWAUWATOSACityNm
State AbbreviationWIStateAbbreviationCd
ZIP53226ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN396069188EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SHEBOYGAN SENIOR COMMUNITY INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlSHEBBusinessNameControlTxt
Phone9204582137PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13505 COUNTY ROAD YAddressLine1Txt
CitySHEBOYGANCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53083ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTARA HOLZEMPersonNm
Person TitleOFFICERPersonTitleTxt
Phone9204582137PhoneNum
Signature2023-03-17SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstTARAPersonFirstNm
Person LastHOLZEMPersonLastNm
FieldValueIRS element (for citing)
SSNXXX-XX-XXXXSSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKRISTEN DONLEVYPreparerPersonNm
PTINP01670215PTIN
Phone4144761880PhoneNum
Preparation2023-03-17PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerTARA HOLZEMPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line13505 COUNTY ROAD YAddressLine1Txt
CitySHEBOYGANCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53083ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$8,669,390GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.SSCNONPROFIT.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1962FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionTO PROVIDE AND OPERATE A RETIREMENT HOME, HEALTH CARE CENTER, AND RELATED SERVICES IN THE GREATER SHEBOYGAN AREA FOR ELDERLY AND PHYSICALLY HANDICAPPED ADULTS.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee174TotalEmployeeCnt
Total Volunteers25TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,195,829PYContributionsGrantsAmt
CY Contributions Grants$165,810CYContributionsGrantsAmt
PY Program Service Revenue$7,301,009PYProgramServiceRevenueAmt
CY Program Service Revenue$8,317,192CYProgramServiceRevenueAmt
PY Investment Income$2,863PYInvestmentIncomeAmt
CY Investment Income$1,400CYInvestmentIncomeAmt
PY Other Revenue$281,533PYOtherRevenueAmt
CY Other Revenue$183,220CYOtherRevenueAmt
PY Total Revenue$8,781,234PYTotalRevenueAmt
CY Total Revenue$8,667,622CYTotalRevenueAmt
PY Grants And Similar Paid$123,074PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$5,408,923PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$5,662,948CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,978,492PYOtherExpensesAmt
CY Other Expenses$3,301,751CYOtherExpensesAmt
PY Total Expenses$8,510,489PYTotalExpensesAmt
CY Total Expenses$8,964,699CYTotalExpensesAmt
PY Revenues Less Expenses$270,745PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$297,077CYRevenuesLessExpensesAmt
Total Assets BOY$15,793,380TotalAssetsBOYAmt
Total Assets EOY$15,183,816TotalAssetsEOYAmt
Total Liabilities BOY$14,867,171TotalLiabilitiesBOYAmt
Total Liabilities EOY$14,554,684TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$926,209NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$629,132NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO PROVIDE AND OPERATE A RETIREMENT HOME, HEALTH CARE CENTER, AND RELATED SERVICES IN THE GREATER SHEBOYGAN AREA FOR ELDERLY AND PHYSICALLY HANDICAPPED ADULTS, WHICH SHALL ENHANCE, HONOR AND PRESERVE THE DIGNITY OF THE INDIVIDUAL, AND WHERE SPIRITUAL, PHYSICAL AND SOCIAL NEEDS ARE SUPPLIED IN A SPIRIT OF CHRISTIAN LOVE AND CONCERN WITHOUT REGARD TO AGE, SEX, RACE, CREED OR COLOR.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$7,182,958ExpenseAmt
Revenue$8,317,924RevenueAmt
DescOPERATION OF A FULL-TIME SKILLED NURSING HOME AND RESIDENTIAL CARE CENTER. TOTAL PATIENT DAYS: 28,818.Desc
Total Program Service Expenses$7,182,958TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document1IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee174EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1TARA HOLZEMBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9204582137PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13505 CTY RD YAddressLine1Txt
CitySHEBOYGANCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53083ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
DAVID VAN DE WATER
DIRECTOR0.500.25Yes (X)$0$0$0
PERRY FRITZ
VICE CHAIRPERSON0.500.25Yes (X)$0$0$0Yes (X)
MEG TRAGER
DIRECTOR0.500.25Yes (X)$0$0$0
ERIC STUART
CHAIRPERSON0.750.25Yes (X)$0$0$0Yes (X)
CINDY THOMPSON
SECRETARY0.500.25Yes (X)$0$0$0Yes (X)
LARRY SAMET
TREASURER0.500.25Yes (X)$0$0$0Yes (X)
MALLY HENNE
DIRECTOR0.500.25Yes (X)$0$0$0
DONNA WENDLANDT
DIRECTOR0.500.25Yes (X)$0$0$0
DAMON WENIG
DIRECTOR0.500.25Yes (X)$0$0$0
TOM BRICKLEY
DIRECTOR0.500.25Yes (X)$0$0$0
BRIAN CHILDS
DIRECTOR0.500.25Yes (X)$0$0$0
CONNIE THIMMIG
DIRECTOR0.500.25Yes (X)$0$0$0
PAUL TREFFERT
CEO39.750.25$195,304$0$0Yes (X)
TARA HOLZEM
BUSINESS OFFICE MANAGER39.750.25$77,357$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$272,661TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GREENFIELD REHABILITATION AGENCYBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line119395 W CAPITAL DRAddressLine1Txt
CityBROOKFIELDCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53045ZIPCd
FieldValueIRS element (for citing)
ServicesTHERAPY SERVICESServicesDesc
Compensation$418,239CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Related Organizations$46,854RelatedOrganizationsAmt
Government Grants$103,183GovernmentGrantsAmt
All Other Contributions$15,773AllOtherContributionsAmt
Total Contributions$165,810TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
SKILLED NURSING FACILI623000$6,752,808$6,752,808
RESIDENTIAL CENTER623000$1,486,454$1,486,454
OTHER SERVICES623000$49,802$49,802
BEAUTY SHOP812900$21,874$21,874
INDEPENDENT LIVING623990$6,254$6,254
FieldValueIRS element (for citing)
Total Program Service Revenue$8,317,192TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$668TotalRevenueColumnAmt
Exclusion$668ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$2,500OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$1,768OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$732OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$732TotalRevenueColumnAmt
Related Or Exempt Func Income$732RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMILESTONES INCOMEDesc
Business623000BusinessCd
Total Revenue Column$183,220TotalRevenueColumnAmt
Exclusion$183,220ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$183,220OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,667,622TotalRevenueColumnAmt
Related Or Exempt Func Income$8,317,924RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$183,888ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$272,661TotalAmt
Management And General$272,661ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,363,193TotalAmt
Program Services$3,863,962ProgramServicesAmt
Management And General$499,231ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$57,725TotalAmt
Program Services$48,778ProgramServicesAmt
Management And General$8,947ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$629,162TotalAmt
Program Services$469,616ProgramServicesAmt
Management And General$159,546ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$340,207TotalAmt
Program Services$287,475ProgramServicesAmt
Management And General$52,732ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$9,254TotalAmt
Management And General$9,254ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$23,564TotalAmt
Management And General$23,564ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,015,818TotalAmt
Program Services$648,129ProgramServicesAmt
Management And General$367,689ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$38,383TotalAmt
Management And General$38,383ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$43,565TotalAmt
Management And General$43,565ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$206,058TotalAmt
Program Services$206,058ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$436,984TotalAmt
Program Services$436,984ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$599,132TotalAmt
Program Services$487,934ProgramServicesAmt
Management And General$111,198ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$76,915TotalAmt
Program Services$76,915ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
SUPPLIES$657,107$657,107
DUES AND SUBSCRIPTIONS$107,708$107,708
BAD DEBT EXPENSE$40,000$40,000
EMPLOYMENT COSTS$39,302$39,302

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$7,961TotalAmt
Management And General$7,961ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$8,964,699TotalAmt
Program Services$7,182,958ProgramServicesAmt
Management And General$1,781,741ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$69,747BOYAmt
EOY$509,954EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$615,532BOYAmt
EOY$337,020EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$636,825BOYAmt
EOY$522,467EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$43,857BOYAmt
EOY$44,464EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$119,854BOYAmt
EOY$107,097EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$17,600,573LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,937,759LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$14,307,565BOYAmt
EOY$13,662,814EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$15,793,380BOYAmt
EOY$15,183,816EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$515,562BOYAmt
EOY$466,270EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$67,970BOYAmt
EOY$108,736EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$12,919,351BOYAmt
EOY$12,615,390EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,364,288BOYAmt
EOY$1,364,288EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$14,867,171BOYAmt
EOY$14,554,684EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$844,828BOYAmt
EOY$538,908EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$81,381BOYAmt
EOY$90,224EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$926,209BOYAmt
EOY$629,132EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$15,793,380BOYAmt
EOY$15,183,816EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$297,077ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$21,605CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$16,329CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$89,080CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,195,829CurrentTaxYearMinus1YearAmt
Current Tax Year$165,810CurrentTaxYearAmt
Total$1,488,653TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,235,002CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,690,907CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,609,554CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,301,009CurrentTaxYearMinus1YearAmt
Current Tax Year$8,317,192CurrentTaxYearAmt
Total$38,153,664TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,256,607CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,707,236CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,698,634CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$8,496,838CurrentTaxYearMinus1YearAmt
Current Tax Year$8,483,002CurrentTaxYearAmt
Total$39,642,317TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$425,314CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$773,588CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$869,298CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$414,826CurrentTaxYearMinus1YearAmt
Current Tax Year$438,159CurrentTaxYearAmt
Total$2,921,185TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$425,314CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$773,588CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$869,298CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$414,826CurrentTaxYearMinus1YearAmt
Current Tax Year$438,159CurrentTaxYearAmt
Total$2,921,185TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$36,721,132PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,209CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$688CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,430CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,863CurrentTaxYearMinus1YearAmt
Current Tax Year$668CurrentTaxYearAmt
Total$6,858TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,209CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$688CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,430CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,863CurrentTaxYearMinus1YearAmt
Current Tax Year$668CurrentTaxYearAmt
Total$6,858TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$281,533CurrentTaxYearMinus1YearAmt
Current Tax Year$183,220CurrentTaxYearAmt
Total$464,753TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,257,816CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,707,924CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,700,064CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$8,781,234CurrentTaxYearMinus1YearAmt
Current Tax Year$8,666,890CurrentTaxYearAmt
Total$40,113,928TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.91540PublicSupportCY509Pct
Public Support PY5090.91790PublicSupportPY509Pct
Investment Income CY0.00020InvestmentIncomeCYPct
Investment Income PY0.00020InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME:FormAndLineReferenceDesc
ExplanationMISCELLANEOUS INCOME - CHANGE IN PRESENT VALUE OF DEVELOPMENT INCENTIVE RECEIVABLE - MILESTONES INCOME - 2020 AMOUNT: $ 281,533. 2021 AMOUNT: $ 183,220.ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$572,217OtherCostOrOtherBasisAmt
Book Value$572,217BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$14,924,551OtherCostOrOtherBasisAmt
Depreciation$2,771,718DepreciationAmt
Book Value$12,152,833BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,481,802OtherCostOrOtherBasisAmt
Depreciation$1,166,041DepreciationAmt
Book Value$315,761BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$622,003OtherCostOrOtherBasisAmt
Book Value$622,003BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$13,662,814TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO AFFILIATEDesc
Amt$1,364,288Amt
FieldValueIRS element (for citing)
Total Liability$1,364,288TotalLiabilityAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonPAUL TREFFERTPersonNm
TitleCEOTitleTxt
Base Compensation Filing Org$177,179BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$0CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$18,125BonusFilingOrganizationAmount
Bonus Related Organizations$0BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$0DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$0DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$0NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$0NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$195,304TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$0TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1ATHE EXECUTIVE COMMITTEE CONDUCTS, BETWEEN MEETINGS OF THE BOARD, THE BUSINESS AFFAIRS OF THE CORPORATION AND CARRY ON CORPORATE OPERATIONS, EXCEPT AS SUCH ACTION RESULTS IN EXPENDITURES OR TRANSFERS OR PROPERTY UP TO THIRTY THOUSAND DOLLARS ($30,000). THERE SHALL BE NO LIMITATION TO TRANSFER FUND TO SHEBOYGAN COMMUNITY FOUNDATION, INC.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 IS PREPARED BY AN INDEPENDENT CPA WITH INFORMATION PROVIDED BY MANAGEMENT. WHEN THE FORM HAS BEEN COMPLETED, A PDF COPY OF FORM 990 IS EMAILED TO THE BUSINESS MANAGER. THE BUSINESS MANAGER FORWARDS THE EMAIL TO THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN. THE 990 IS REVIEWED BY THE BUSINESS MANAGER, CEO, AND DIRECTOR OF OPERATIONS PRIOR TO FILING. THE BUSINESS MANAGER CHECKS FORM 990 WITH INTERNAL REPORTS.
FORM 990, PART VI, SECTION B, LINE 12CEACH TRUSTEE SHALL DISCLOSE TO THE BOARD OF TRUSTEES DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST, WHENEVER THE DUALITY OR CONFLICT PERTAINS TO A MATTER BEING CONSIDERED BY THE BOARD. ANY TRUSTEE HAVING DUALITY OF INTEREST OR CONFLICT OF INTEREST ON ANY MATTER, SHALL ABSTAIN FROM VOTING ON THE MATTER AND SHALL NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE VOTE ON THE MATTER. THE MINUTES OF THE MEETING INVOLVING ANY SUCH SITUATION SHALL REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING AND THE QUORUM SITUATION. FAILURE TO DISCLOSE DUALITY OF INTEREST OR CONFLICT OF INTEREST WHILE PARTICIPATING IN THE VOTE FOR BOARD ACTION SHALL BE REASON FOR REMOVAL FROM OFFICE. IF A TRUSTEE IS UNCERTAIN AS TO WHETHER HE OR SHE HAS A DUALITY OR CONFLICT OF INTEREST WHICH REQUIRES ABSTENTION, OR IF A TRUSTEE ASSERTS THAT ANOTHER TRUSTEE HAS SUCH DUALITY OR CONFLICT, THE BOARD, BY MAJORITY VOTE OF THOSE PRESENT, OTHER THAN THE TRUSTEE HAVING THE POSSIBLE CONFLICT, SHALL DECIDE WHETHER ABSTENTION IS REQUIRED. IF SO, THE TRUSTEE SHALL BE DEEMED TO HAVE ABSTAINED.
FORM 990, PART VI, SECTION B, LINE 15ASHEBOYGAN SENIOR COMMUNITY, INC. USES DATA GATHERED FOR THEIR STATE ASSOCIATION (WISCONSIN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING) BY MANAGEMENT RESOURCE ASSOCIATES (MRA), A THIRD PARTY INDEPENDENT, NOT FOR PROFIT, MANAGEMENT CONSULTING GROUP. THE DATA IS GATHERED FROM PARTICIPATING NOT FOR PROFIT HOMES THROUGHOUT THE STATE OF WISCONSIN. CLIFTONLARSONALLEN ALSO COMPLETED A COMPENSATION BENCHMARK REPORT FOR A CEO POSITION. SALARY RECOMMENDATIONS FOR THE EXECUTIVE DIRECTOR ARE REVIEWED AND SET BY THE EXECUTIVE COMMITTEE IN AN EXECUTIVE SESSION WITHOUT THE EXECUTIVE DIRECTOR'S PRESENCE AFTER THE FULL ANNUAL PERFORMANCE EVALUATION, UTILIZING THE DATA DESCRIBED ABOVE. NO OTHER MANAGEMENT STAFF ARE REVIEWED IN THIS MANNER, THOUGH ALL SALARY AND EXPENSE DATA IS REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD IN THEIR ANNUAL BUDGET PREPARATION AND APPROVAL.
FORM 990, PART VI, SECTION C, LINE 19THESE DOCUMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11GPURCHASED SERVICES: PROGRAM SERVICE EXPENSES 648,129. MANAGEMENT AND GENERAL EXPENSES 367,689. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,015,818.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1SHEBOYGAN SENIOR COMMUNITY FOUNDATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13505 CTY RD YAddressLine1Txt
CitySHEBOYGANCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53083ZIPCd
FieldValueIRS element (for citing)
EIN391450846EIN
Primary ActivitiesRAISE/RECEIVE FUNDS TO BE USED FOR GENERAL SUPPORT OF THIS ORGANIZATIONPrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 12B, IIPublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1SHEBOYGAN SENIOR COMMUNITY INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationYes (1)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (1)LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1SHEBOYGAN SENIOR COMMUNITY FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeETransactionTypeTxt
Involved$46,854InvolvedAmt
Method Of Amount DeterminationYEAR END BALANCEMethodOfAmountDeterminationTxt

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