SHEBOYGAN SENIOR COMMUNITY INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
SHEBOYGAN SENIOR COMMUNITY INC (EIN 39-6069188)
Tax period
2020-07-01 to 2021-06-30
Filed
2022-04-28
IRS object ID
202241189349300019
Schema version
2020v4.2
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)
Return2022-04-28T09:49:20-05:00ReturnTs
Tax Period End2021-06-30TaxPeriodEndDt

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 Line18215 GREENWAY BOULEVARD SUITE 600AddressLine1Txt
CityMIDDLETONCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53562ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-07-01TaxPeriodBeginDt

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
Signature2022-04-13SignatureDt
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 PersonKIMBERLY ANDERSONPreparerPersonNm
PTINP00188889PTIN
Phone6086628600PhoneNum
Preparation2022-04-13PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

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$8,781,234GrossReceiptsAmt
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 Body11VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee210TotalEmployeeCnt
Total Volunteers25TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$89,080PYContributionsGrantsAmt
CY Contributions Grants$1,195,829CYContributionsGrantsAmt
PY Program Service Revenue$7,609,554PYProgramServiceRevenueAmt
CY Program Service Revenue$7,301,009CYProgramServiceRevenueAmt
PY Investment Income$1,432PYInvestmentIncomeAmt
CY Investment Income$2,863CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$281,533CYOtherRevenueAmt
PY Total Revenue$7,700,066PYTotalRevenueAmt
CY Total Revenue$8,781,234CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$123,074CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$5,019,027PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$5,408,923CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,984,222PYOtherExpensesAmt
CY Other Expenses$2,978,492CYOtherExpensesAmt
PY Total Expenses$8,003,249PYTotalExpensesAmt
CY Total Expenses$8,510,489CYTotalExpensesAmt
PY Revenues Less Expenses-$303,183PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$270,745CYRevenuesLessExpensesAmt
Total Assets BOY$16,797,072TotalAssetsBOYAmt
Total Assets EOY$15,793,380TotalAssetsEOYAmt
Total Liabilities BOY$16,141,608TotalLiabilitiesBOYAmt
Total Liabilities EOY$14,867,171TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$655,464NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$926,209NetAssetsOrFundBalancesEOYAmt
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$7,101,053ExpenseAmt
Grant$123,074GrantAmt
Revenue$7,301,009RevenueAmt
DescOPERATION OF A FULL-TIME SKILLED NURSING HOME AND RESIDENTIAL CARE CENTER. TOTAL PATIENT DAYS: 26,784.Desc
Total Program Service Expenses$7,101,053TotalProgramServiceExpensesAmt
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 OrganizationsYes (1)GrantsToOrganizationsInd
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 ContriYes (1)DeductibleNonCashContriInd
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
Employee210EmployeeCnt
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 Members11GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
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 (15 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)
KEITH ISKEN
DIRECTOR0.500.25Yes (X)$0$0$0
MALLY HENNE
DIRECTOR0.500.25Yes (X)$0$0$0
DONNA WENDLANDT
DIRECTOR0.500.25Yes (X)$0$0$0
LAURA RECTOR
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 CHILD
DIRECTOR0.500.25Yes (X)$0$0$0
PAUL TREFFERT
CEO39.750.25$160,581$0$19,000Yes (X)
TARA HOLZEM
BUSINESS OFFICE MANAGER39.750.25$78,614$0$1,599Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$239,195TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$20,599TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
GREENFIELD REHABILITATION AGENCY
19395 W CAPITAL DRBROOKFIELDWI53045THERAPY SERVICES$287,279
AG ARCHITECTURE
1414 UNDERWOOD AVE SUITE 301WAUWATOSAWI53213ARCHITECTURE SERVICES$157,884
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
Related Organizations$9,323RelatedOrganizationsAmt
Government Grants$1,128,818GovernmentGrantsAmt
All Other Contributions$57,688AllOtherContributionsAmt
Noncash Contributions$36,586NoncashContributionsAmt
Total Contributions$1,195,829TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
SKILLED NURSING FACILI900099$5,809,791$5,809,791
RESIDENTIAL CENTER623000$1,397,379$1,397,379
OTHER SERVICES900099$69,693$69,693
BEAUTY SHOP812900$19,688$19,688
INDEPENDENT LIVING623990$4,458$4,458
FieldValueIRS element (for citing)
Total Program Service Revenue$7,301,009TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,863TotalRevenueColumnAmt
Exclusion$2,863ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMILESTONES INCOMEDesc
Business900099BusinessCd
Total Revenue Column$281,533TotalRevenueColumnAmt
Exclusion$281,533ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$281,533OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,781,234TotalRevenueColumnAmt
Related Or Exempt Func Income$7,301,009RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$284,396ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$123,074TotalAmt
Program Services$123,074ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$247,598TotalAmt
Management And General$247,598ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,116,373TotalAmt
Program Services$3,653,057ProgramServicesAmt
Management And General$463,316ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$69,598TotalAmt
Program Services$60,415ProgramServicesAmt
Management And General$9,183ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$610,506TotalAmt
Program Services$526,037ProgramServicesAmt
Management And General$84,469ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$364,848TotalAmt
Program Services$316,708ProgramServicesAmt
Management And General$48,140ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$29,569TotalAmt
Management And General$29,569ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$22,768TotalAmt
Management And General$22,768ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$693,188TotalAmt
Program Services$577,364ProgramServicesAmt
Management And General$115,824ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$53,946TotalAmt
Management And General$53,946ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$42,559TotalAmt
Management And General$42,559ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$196,067TotalAmt
Program Services$196,067ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$452,895TotalAmt
Program Services$452,895ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$599,837TotalAmt
Program Services$493,672ProgramServicesAmt
Management And General$106,165ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$83,147TotalAmt
Program Services$83,147ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
SUPPLIES$618,617$618,617
DUES AND SUBSCRIPTIONS$100,206$100,206
EMPLOYMENT COSTS$39,817$39,817
BAD DEBT EXPENSE$38,092$38,092

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$7,784TotalAmt
Management And General$7,784ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$8,510,489TotalAmt
Program Services$7,101,053ProgramServicesAmt
Management And General$1,409,436ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$211,575BOYAmt
EOY$69,747EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,252,515BOYAmt
EOY$615,532EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$434,951BOYAmt
EOY$636,825EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$36,299BOYAmt
EOY$43,857EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$111,739BOYAmt
EOY$119,854EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$17,648,843LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,341,278LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$14,749,993BOYAmt
EOY$14,307,565EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$16,797,072BOYAmt
EOY$15,793,380EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$391,334BOYAmt
EOY$515,562EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$137,417BOYAmt
EOY$67,970EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$13,398,169BOYAmt
EOY$12,919,351EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,214,688BOYAmt
EOY$1,364,288EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$16,141,608BOYAmt
EOY$14,867,171EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$571,691BOYAmt
EOY$844,828EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$83,773BOYAmt
EOY$81,381EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$655,464BOYAmt
EOY$926,209EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$16,797,072BOYAmt
EOY$15,793,380EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$270,745ReconcilationRevenueExpnssAmt
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$39,679CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$21,605CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$16,329CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$89,080CurrentTaxYearMinus1YearAmt
Current Tax Year$345,429CurrentTaxYearAmt
Total$512,122TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,325,061CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,235,002CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,690,907CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,609,554CurrentTaxYearMinus1YearAmt
Current Tax Year$7,301,009CurrentTaxYearAmt
Total$37,161,533TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,364,740CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,256,607CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,707,236CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,698,634CurrentTaxYearMinus1YearAmt
Current Tax Year$7,646,438CurrentTaxYearAmt
Total$37,673,655TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$15,000CurrentTaxYearMinus4YearsAmt
Total$15,000TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$257,760CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$425,314CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$773,588CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$869,298CurrentTaxYearMinus1YearAmt
Current Tax Year$414,826CurrentTaxYearAmt
Total$2,740,786TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$272,760CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$425,314CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$773,588CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$869,298CurrentTaxYearMinus1YearAmt
Current Tax Year$414,826CurrentTaxYearAmt
Total$2,755,786TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$34,917,869PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$339CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,209CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$688CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,430CurrentTaxYearMinus1YearAmt
Current Tax Year$2,863CurrentTaxYearAmt
Total$6,529TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$339CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,209CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$688CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,430CurrentTaxYearMinus1YearAmt
Current Tax Year$2,863CurrentTaxYearAmt
Total$6,529TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$79,038CurrentTaxYearMinus4YearsAmt
Current Tax Year$281,533CurrentTaxYearAmt
Total$360,571TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,444,117CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,257,816CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,707,924CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,700,064CurrentTaxYearMinus1YearAmt
Current Tax Year$7,930,834CurrentTaxYearAmt
Total$38,040,755TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.91790PublicSupportCY509Pct
Public Support PY5090.93060PublicSupportPY509Pct
Investment Income CY0.00020InvestmentIncomeCYPct
Investment Income PY0.00010InvestmentIncomePYPct
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 - 2016 AMOUNT: $ 79,038. MILESTONES INCOME - 2020 AMOUNT: $ 281,533.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$2,345,223DepreciationAmt
Book Value$12,579,328BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,297,856OtherCostOrOtherBasisAmt
Depreciation$996,055DepreciationAmt
Book Value$301,801BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$854,219OtherCostOrOtherBasisAmt
Book Value$854,219BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$14,307,565TotalBookValueLandBuildingsAmt

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 I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1LANDMARK SQUARE CONDOMINIUM ASSOCIATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1832 NORTH 6TH STREETAddressLine1Txt
CitySHEBOYGANCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53081ZIPCd
FieldValueIRS element (for citing)
Recipient EIN391423070RecipientEIN
Non Cash Assistance$123,074NonCashAssistanceAmt
Valuation Method UsedBOOK VALUEValuationMethodUsedDesc
Non Cash AssistanceFITNESS CENTER AND SALONNonCashAssistanceDesc
Purpose Of GrantGRANTED REMAINING INTEREST IN LANDMARK SQUARE TO THE ORGANIZATION UPON TERMINATION OF THE MANAGEMENT AGREEMENT BETWEEN THE TWO ORGANIZATIONS.PurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

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$160,581BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$0CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$0BonusFilingOrganizationAmount
Bonus Related Organizations$0BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$19,000DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$0DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$0NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$0NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$179,581TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$0TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Schedule M IRS990ScheduleM

Other Non Cash Contri Table OtherNonCashContriTableGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
DescTHERAPY BATHROOMDesc
Contribution1ContributionCnt
Noncash Contributions Rpt F990$36,586NoncashContributionsRptF990Amt
Method Of Determining RevenuesFMVMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1THE 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.

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$1,364,288InvolvedAmt
Method Of Amount DeterminationYEAR END BALANCEMethodOfAmountDeterminationTxt

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