2022-04-28T09:49:20-05:00 2021-06-30 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2020-07-01 396069188 SHEBOYGAN SENIOR COMMUNITY INC SHEB 9204582137 3505 COUNTY ROAD Y SHEBOYGAN WI 53083 TARA HOLZEM OFFICER 9204582137 2022-04-13 1 TARA HOLZEM XXX-XX-XXXX KIMBERLY ANDERSON P00188889 6086628600 2022-04-13 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z TARA HOLZEM 3505 COUNTY ROAD Y SHEBOYGAN WI 53083 8781234 0 X WWW.SSCNONPROFIT.ORG X 1962 WI TO PROVIDE AND OPERATE A RETIREMENT HOME, HEALTH CARE CENTER, AND RELATED SERVICES IN THE GREATER SHEBOYGAN AREA FOR ELDERLY AND PHYSICALLY HANDICAPPED ADULTS. 11 11 210 25 0 0 89080 1195829 7609554 7301009 1432 2863 0 281533 7700066 8781234 0 123074 0 0 5019027 5408923 0 0 0 2984222 2978492 8003249 8510489 -303183 270745 16797072 15793380 16141608 14867171 655464 926209 X TO 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. 0 0 7101053 123074 7301009 OPERATION OF A FULL-TIME SKILLED NURSING HOME AND RESIDENTIAL CARE CENTER. TOTAL PATIENT DAYS: 26,784. 7101053 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 1 0 1 210 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X TARA HOLZEM 9204582137 3505 CTY RD Y SHEBOYGAN WI 53083 DAVID VAN DE WATER DIRECTOR 0.50 0.25 X 0 0 0 PERRY FRITZ VICE CHAIRPERSON 0.50 0.25 X X 0 0 0 MEG TRAGER DIRECTOR 0.50 0.25 X 0 0 0 ERIC STUART CHAIRPERSON 0.75 0.25 X X 0 0 0 CINDY THOMPSON SECRETARY 0.50 0.25 X X 0 0 0 LARRY SAMET TREASURER 0.50 0.25 X X 0 0 0 KEITH ISKEN DIRECTOR 0.50 0.25 X 0 0 0 MALLY HENNE DIRECTOR 0.50 0.25 X 0 0 0 DONNA WENDLANDT DIRECTOR 0.50 0.25 X 0 0 0 LAURA RECTOR DIRECTOR 0.50 0.25 X 0 0 0 DAMON WENIG DIRECTOR 0.50 0.25 X 0 0 0 TOM BRICKLEY DIRECTOR 0.50 0.25 X 0 0 0 BRIAN CHILD DIRECTOR 0.50 0.25 X 0 0 0 PAUL TREFFERT CEO 39.75 0.25 X 160581 0 19000 TARA HOLZEM BUSINESS OFFICE MANAGER 39.75 0.25 X 78614 0 1599 239195 0 20599 1 0 1 0 GREENFIELD REHABILITATION AGENCY 19395 W CAPITAL DR BROOKFIELD WI 53045 THERAPY SERVICES 287279 AG ARCHITECTURE 1414 UNDERWOOD AVE SUITE 301 WAUWATOSA WI 53213 ARCHITECTURE SERVICES 157884 2 9323 1128818 57688 36586 1195829 SKILLED NURSING FACILI 900099 5809791 5809791 RESIDENTIAL CENTER 623000 1397379 1397379 OTHER SERVICES 900099 69693 69693 BEAUTY SHOP 812900 19688 19688 INDEPENDENT LIVING 623990 4458 4458 7301009 2863 2863 MILESTONES INCOME 900099 281533 281533 281533 8781234 7301009 0 284396 123074 123074 247598 247598 4116373 3653057 463316 69598 60415 9183 610506 526037 84469 364848 316708 48140 29569 29569 22768 22768 693188 577364 115824 53946 53946 42559 42559 196067 196067 452895 452895 599837 493672 106165 83147 83147 SUPPLIES 618617 618617 DUES AND SUBSCRIPTIONS 100206 100206 EMPLOYMENT COSTS 39817 39817 BAD DEBT EXPENSE 38092 38092 7784 7784 8510489 7101053 1409436 0 211575 69747 1252515 615532 434951 636825 36299 43857 111739 119854 17648843 3341278 14749993 14307565 16797072 15793380 391334 515562 137417 67970 13398169 12919351 2214688 1364288 16141608 14867171 X 571691 844828 83773 81381 655464 926209 16797072 15793380 270745 0 X 0 1 X 1 0 X 39679 21605 16329 89080 345429 512122 7325061 7235002 7690907 7609554 7301009 37161533 7364740 7256607 7707236 7698634 7646438 37673655 15000 15000 257760 425314 773588 869298 414826 2740786 272760 425314 773588 869298 414826 2755786 34917869 339 1209 688 1430 2863 6529 339 1209 688 1430 2863 6529 79038 281533 360571 7444117 7257816 7707924 7700064 7930834 38040755 0.91790 0.93060 0.00020 0.00010 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - CHANGE IN PRESENT VALUE OF DEVELOPMENT INCENTIVE RECEIVABLE - 2016 AMOUNT: $ 79,038. MILESTONES INCOME - 2020 AMOUNT: $ 281,533. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 572217 572217 14924551 2345223 12579328 1297856 996055 301801 854219 854219 14307565 DUE TO AFFILIATE 1364288 1364288 1 LANDMARK SQUARE CONDOMINIUM ASSOCIATION 832 NORTH 6TH STREET SHEBOYGAN WI 53081 391423070 123074 BOOK VALUE FITNESS CENTER AND SALON GRANTED REMAINING INTEREST IN LANDMARK SQUARE TO THE ORGANIZATION UPON TERMINATION OF THE MANAGEMENT AGREEMENT BETWEEN THE TWO ORGANIZATIONS. 1 0 0 0 0 0 0 0 0 0 PAUL TREFFERT CEO 160581 0 0 0 0 0 19000 0 0 0 179581 0 0 0 X THERAPY BATHROOM 1 36586 FMV 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE 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 11B THE 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 12C EACH 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 15A SHEBOYGAN 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 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. SHEBOYGAN SENIOR COMMUNITY FOUNDATION 3505 CTY RD Y SHEBOYGAN WI 53083 391450846 RAISE/RECEIVE FUNDS TO BE USED FOR GENERAL SUPPORT OF THIS ORGANIZATION WI 501(C)(3) LINE 12B, II SHEBOYGAN SENIOR COMMUNITY INC 1 0 0 1 0 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 SHEBOYGAN SENIOR COMMUNITY FOUNDATION INC E 1364288 YEAR END BALANCE