2022-05-13T13:08:05-05:00 2021-06-30 420714325 RSM US LLP PO BOX 5946 MADISON WI 537050946 990 2020-07-01 391025444 CEDAR CREST INC CEDA 6087560344 1702 SOUTH RIVER ROAD JANESVILLE WI 53546 DAVID TANCK PRESIDENT/CEO 6087560344 2022-05-13 1 DAVID TANCK 999009999 JAMES G GRAHAM P00006111 6086332612 2022-05-12 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z DAVID TANCK 1702 SOUTH RIVER ROAD JANESVILLE WI 53546 15719717 0 X CEDARCRESTLIFE.COM X 2003 WI CEDAR CREST IS A CONTINUING CARE RETIREMENT COMMUNITY SERVING ADULTS 55 YEARS OF AGE OR OLDER. ITS MISSION IS TO ENRICH THE QUALITY OF LIFE FOR SENIOR ADULTS AT ALL LEVELS OF INDEPENDENCE, GUIDED BY A SPIRITUALLY BASED, NOT-FOR-PROFIT CULTURE THAT FOSTERS COMPASSION AND CARE. 12 12 360 0 0 0 1851433 715442 15975169 14614814 104408 38861 -3659 350600 17927351 15719717 0 0 0 0 9621916 9702136 0 0 0 6309464 6278856 15931380 15980992 1995971 -261275 45805616 47272483 30444225 31830346 15361391 15442137 X SEE SCHEDULE O 0 0 8438630 6873980 SEE SCHEDULE O 1571151 2962400 SEE SCHEDULE O 3037760 2638638 SEE SCHEDULE O 1134872 2139796 THE CEDAR CREST MEMORY CARE UNIT IS A 24 BED LICENSED CBRF PROVIDING SERVICES TO THOSE INDIVIDUALS WHO HAVE BEEN DIAGNOSED WITH ALZHEIMER OR OTHER DEMENTIA RELATED DISEASES. THE PROGRAM PROVIDES SERVICES TO RESIDENTS WHO REQUIRE LIMITED NURSING CARE BUT NEED ASSISTANCE WITH DAILY LIVING ACTIVITIES. THE PROGRAM IS STAFFED 24 HOURS PER DAY, SEVEN DAYS A WEEK WITH PERSONAL CARE WORKERS AND CERTIFIED NURSING ASSISTANTS. IT IS ALSO STAFFED WITH AN RN MEMORY CARE MANAGER. UP TO 3 HOURS OF NURSING CARE PER WEEK IS PROVIDED (DIRECTLY BY AN RN) AND UNLIMITED NUMBER OF HOURS OF CARE WITH DAILY LIVING ACTIVITIES. THIS CARE INCLUDES BATHING AND DRESSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, ACTIVITIES MEETING THE NEEDS OF EACH RESIDENT, FEEDING, THREE MEALS PER DAY AND OTHER NUTRITIONAL NEEDS BASED ON THE INDIVIDUAL RESIDENT, LAUNDRY, HOUSEKEEPING, TOILETING, DRESSING CHANGES, MEDICATION ADMINISTRATION AND MANAGEMENT, SCHEDULING OF MEDICAL APPOINTMENTS, TRANSPORTATION TO MEDICAL APPOINTMENTS, COORDINATING CARE UNDER THE DIRECTION OF THE RESIDENT'S DOCTOR AS WELL AS OTHER UNIQUE NEEDS OF EACH INDIVIDUAL RESIDENT. A TOTAL OF 8,442 RESIDENT CARE DAYS WERE PROVIDED. 1134872 2139796 14182413 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 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 1 0 0 0 1 54 0 1 360 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X DAVID TANCK 6087560344 1702 SOUTH RIVER ROAD JANESVILLE WI 53546 DAVID TANCK PRESIDENT/CEO 39.00 1.00 X 197561 0 33477 MEREDITH AARUD VICE PRESIDENT 39.00 1.00 X 118180 0 23725 RENEE ROSENCRANS REGISTERED NURSE 53.00 X 128117 0 0 DIANE SCHEWE REGISTERED NURSE 42.00 X 103681 0 13447 CHRISTOPHER MULAE CONTROLLER 39.00 1.00 X 99501 0 11211 REV FORREST WELLS DIRECTOR 1.00 X 0 0 0 BARBARA KELLEY DIRECTOR 1.00 X 0 0 0 DIANE PILLARD DIRECTOR 1.00 X 0 0 0 MARK LORENZ DIRECTOR 1.00 X 0 0 0 REV STEVE SCOTT DIRECTOR 1.00 X 0 0 0 THOMAS LASSE DIRECTOR 1.00 X 0 0 0 CAROL HATCH DIRECTOR 1.00 X 0 0 0 JEN DEGARMO DIRECTOR 1.00 X 0 0 0 SARAH SWANTEK DIRECTOR 1.00 X 0 0 0 SEAN KNOTT DIRECTOR UNTIL 6/30/2021 1.00 X 0 0 0 GERALD KELM DIRECTOR/CHAIR 1.00 X X 0 0 0 TARI MILLER DIRECTOR/TREASURER/SECRETARY 1.00 X X 0 0 0 647040 0 81860 4 0 1 0 NAATZ CONSTRUCTION 130 FOOTVILLE HANOVER ROAD JANESVILLE WI 53548 CONSTRUCTION SERVICES 1519815 REHAB CARE GROUP PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 957656 RT FOX CONTRACTORS PO BOX 331 EDGERTON WI 53534 CONSTRUCTION SERVICES 475089 ZONES 1102 15TH ST SW SUITE 102 AUBURN WA 98001 TECHNOLOGY SERVICES 186646 HEALTHCARE SERVICES GROUP PO BOX 829677 PHILADELPHIA PA 19182 HOUSEKEEPING MANAGEMENT SERVICES 164077 9 668903 46539 715442 HEALTH CENTER 623990 6873980 6873980 RETIREMENT APARTMENTS 623990 2962400 2962400 ASSISTED LIVING 623990 2638638 2638638 MEMORY CARE 623990 1699007 1699007 WATERFORD GROVE 623990 369834 369834 70955 70955 14614814 38861 38861 EMPLOYEE RETENTION CREDIT 900099 350600 350600 350600 15719717 14614814 0 389461 343537 133684 209853 7284439 6833733 450706 162136 148096 14040 1363685 1245594 118091 548339 500855 47484 165728 165728 6189 6189 77824 77824 522239 310062 212177 22047 22047 61855 61855 81255 81255 1183052 1121536 61516 136 136 233886 233886 1781356 1773836 7520 130675 130675 THERAPY 973545 973545 SUPPLIES 391101 347664 43437 FOOD 370173 370173 REPAIRS 217286 18790 198496 60509 5231 55278 15980992 14182413 1798579 0 3785372 2721207 3974030 5506507 716779 692955 297831 284964 64609581 28462971 33957524 36146610 2315808 964665 758272 955575 45805616 47272483 1980614 2269606 13368434 15082477 15095177 14478263 30444225 31830346 X 14596785 14499952 764606 942185 15361391 15442137 45805616 47272483 X -261275 144718 197303 X 0 1 X 1 0 X 49485 54354 54769 1851433 715442 2725483 13784617 14751665 15591795 15975169 14614814 74718060 13834102 14806019 15646564 17826602 15330256 77443543 0 0 0 77443543 50893 76963 106902 104408 38861 378027 50893 76963 106902 104408 38861 378027 350600 350600 13884995 14882982 15753466 17931010 15719717 78172170 0.99070 0.99490 0.00480 0.00510 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: EMPLOYEE RETENTION CREDIT - 2020 AMOUNT: $ 350,600. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 815808 154457 5600 964665 766807 54601 5600 815808 716538 55869 5600 766807 691659 30479 5600 716538 640487 56772 5600 691659 1.00000 1 0 977257 977257 50700151 22678363 28021788 7104987 3178086 3926901 5827186 2606522 3220664 36146610 X PART V, LINE 4: ENDOWMENT FUNDS ARE USED TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO INTENDED SERVICES AND PROGRAMS PART X, LINE 2: THE CORPORATION IS EXEMPT FROM INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). ACCORDINGLY, THERE IS NO PROVISION FOR FEDERAL OR STATE INCOME TAXES. THE CORPORATION FILES FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THIS RETURN IS FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH CARE ORGANIZATIONS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX-EXEMPT STATUS OF EACH ENTITY, THE CONTINUED TAX-EXEMPT STATUS OF BONDS ISSUED AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). UBIT IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. FORM 990 FILED BY THE CORPORATION IS SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF THE RETURN. X X X 0 0 0 0 0 0 0 0 0 DAVID TANCK PRESIDENT/CEO 197561 0 0 0 0 0 6084 0 27393 0 231038 0 0 0 A WHEFA ADJUSTABLE RATE REFUNDING REVENUE BONDS SERIES 2013 391337855 2013-12-30 18005000 PROVIDE FUNDS TO REFUND A PRIOR ISSUE 0 0 0 A 3450000 18005000 63740 17941260 1 0 1 1 A 0 0 0 0 1 0 0 A 1 1 1 BMO HARRIS BANK 6.830000000000 0 0 0 0 0 A 0 FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: CEDAR CREST'S MISSION IS TO "ENRICH THE QUALITY OF LIFE FOR SENIOR ADULTS AT ALL LEVELS OF INDEPENDENCE, GUIDED BY A SPIRITUALLY BASED, NOT-FOR-PROFIT CULTURE THAT FOSTERS COMPASSION AND CARE." AS A SPIRTUALLY BASED ORGANIZATION, WE BELIEVE EACH PERSON WHETHER RESIDENT, STAFF, VOLUNTEER, OR NEIGHBOR IS A PRECIOUS GIFT TO BE TREATED WITH RESPECT IN BODY, MIND, AND SPIRIT. WE BELIEVE SENIOR ADULTS DESERVE TO LIVE THEIR FULL LIFE WITH DIGNITY. THEREFORE, WE ARE DEDICATED TO TREATING EACH PERSON WHO LIVES AT CEDAR CREST AS AN IMPORTANT AND UNIQUE INDIVIDUAL AND TO PROVIDE THE SUPPORT NEEDED TO ENHANCE THE LIVES OF OUR RESIDENTS. THROUGH INTEGRITY AND PROFESSIONALISM, CLEAR AND INCLUSIVE COMMUNICATION, A DIVERSE AND DYNAMIC ARRAY OF LIVING AND SERVICE OPTIONS, A RESPECT FOR INDIVIDUAL EXPERIENCES AND CHOICES, AND A CORPORATE CULTURE OF EXCELLENT CUSTOMER SERVICE, WE STRIVE TO HELP EACH RESIDENT ACHIEVE THE HIGHEST QUALITY OF LIFE POSSIBLE. FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS: CEDAR VIEW IS A SKILLED NURSING FACILITY PROVIDING 24 HOUR COMPLETE CARE OF EACH RESIDENT INCLUDING BUT NOT LIMITED TO: FEEDING, THREE MEALS PER DAY PLUS SNACKS BASED ON INDIVIDUAL DIET NEEDS, NUTRITION MANAGEMENT, BATHING AND DRESSING, LAUNDRY, HOUSEKEEPING, TOILETING, MEDICATIONS ADMINISTRATION AND MANAGEMENT, DRESSING CHANGES, RESTORATIVE PROGRAM BASED ON THE INDIVIDUAL RESIDENT'S NEEDS, REHABILITATION SERVICES INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, ACTIVITIES MEETING THE INDIVIDUAL NEEDS OF EACH RESIDENT, TUBE FEEDING, DEVELOPMENT OF AND IMPLEMENTING FOR EACH RESIDENT A COMPLETE INDIVIDUAL CARE PLAN, SCHEDULING OF MEDICAL APPOINTMENTS, TRANSPORTATION TO MEDICAL APPOINTMENTS, COORDINATING CARE UNDER THE DIRECTION OF THE RESIDENT'S DOCTOR. THE PROGRAM IS LICENSED AS A 71 BED SKILLED NURSING FACILITY. THE PROGRAM IS MEDICARE AND MEDICAID CERTIFIED AND PROVIDES SERVICES TO RESIDENTS WHO PAY PRIVATELY AS WELL AS THOSE RESIDENTS WHO ARE ENTITLED TO MEDICARE AND MEDICAID BENEFITS. A TOTAL OF 18,638 RESIDENT CARE DAYS WERE PROVIDED. FORM 990, PART III, LINE 4B, PROGRAM SERVICE ACCOMPLISHMENTS: WATERFORD PLACE APARTMENTS ARE REGISTERED WITH THE STATE OF WISCONSIN AS A RESIDENTIAL CARE APARTMENT COMPLEX (RCAC). THIS LICENSURE ALLOWS RESIDENTS WHO HAVE CHOSEN AN INDEPENDENT LIVING SETTING WITHIN THE CEDAR CREST COMMUNITY TO "AGE IN PLACE" THROUGH THE PROVISION OF SERVICES IN THEIR APARTMENT. THE SERVICES PROVIDE FOR UP TO 28 HOURS OF NURSING AND PERSONAL CARE SERVICES AND ARE SCHEDULED BASED ON NURSING ASSESSMENT AND RISK AGREEMENT BETWEEN THE RESIDENT AND CEDAR CREST. THERE ARE 103 APARTMENTS UNDER THE RCAC REGISTRATION WITH APPROXIMATELY 33,137 DAYS OF SERVICE BEING PROVIDED TO THE RESIDENTS. FORM 990, PART III, LINE 4C, PROGRAM SERVICE ACCOMPLISHMENTS: TERRACE RIDGE ASSISTED LIVING IS A 44 BED COMMUNITY BASED ON RESIDENTIAL FACILITY (CBRF) WHICH IS LICENSED BY THE STATE OF WISCONSIN. THE PROGRAM PROVIDES SERVICES TO RESIDENTS WHO REQUIRE LIMITED NURSING CARE BUT NEED VARYING LEVELS OF ASSISTANCE WITH DAILY LIVING ACTIVITIES. THE PROGRAM IS STAFFED 24 HOURS PER DAY, SEVEN DAYS A WEEK WITH PERSONAL CARE WORKERS AND CERTIFIED NURSING ASSISTANTS. IT IS ALSO STAFFED WITH A FULL TIME RN ASSISTED LIVING MANAGER. UP TO 3 HOURS OF NURSING CARE PER WEEK IS PROVIDED (DIRECTLY BY AN RN) AND UNLIMITED NUMBER OF HOURS OF CARE WITH DAILY LIVING ACTIVITIES. THIS CARE INCLUDES BATHING AND DRESSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, ACTIVITIES MEETING THE NEEDS OF EACH RESIDENT, FEEDING, THREE MEALS PER DAY AND OTHER NUTRITIONAL NEEDS BASED ON THE INDIVIDUAL RESIDENT, LAUNDRY, HOUSEKEEPING, TOILETING, DRESSING CHANGES, MEDICATION ADMINISTRATION AND MANAGEMENT, SCHEDULING OF MEDICAL APPOINTMENTS, TRANSPORTATION TO MEDICAL APPOINTMENTS, COORDINATING CARE UNDER THE DIRECTION OF THE RESIDENT'S DOCTOR AS WELL AS OTHER UNIQUE NEEDS OF EACH INDIVIDUAL RESIDENT. A TOTAL OF 15,059 RESIDENT CARE DAYS WERE PROVIDED. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS MADE AVAILABLE TO THE BOARD PRIOR TO FILING, AND REVIEWED IN DETAIL WITH THE AUDIT COMMITTEE AND BOARD SUBSEQUENT TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED WITH EACH NEW BOARD MEMBER AND THE NEW BOARD MEMBER SIGNS A CONFLICT OF INTEREST STATEMENT BEFORE ATTENDING THE FIRST BOARD MEETING. ANNUALLY THE CONFLICT OF INTEREST POLICY IS REVIEWED WITH ALL BOARD MEMBERS AND MANAGERS AND AN UPDATED CONFLICT OF INTEREST STATEMENT IS REQUIRED TO BE COMPLETED BY ALL BOARD MEMBERS AND MANAGERS. THE CONFLICT OF INTEREST STATEMENTS ARE SUMMARIZED AND REVIEWED BY THE GOVERNANCE COMMITTEE AND ANY CONFLICTS ARE REPORTED TO THE BOARD OF DIRECTORS BY THE GOVERNANCE COMMITTEE. IF A CONFLICT OF INTEREST IS DISCOVERED THAT WAS NOT DISCLOSED ON THE CONFLICT OF INTEREST STATEMENT, THE ISSUE IS DIRECTED TO THE GOVERNANCE COMMITTEE FOR RESOLUTION. FORM 990, PART VI, SECTION B, LINE 15A EACH YEAR THE EXECUTIVE COMMITTEE GATHERS MARKET DATA FOR DETERMINING COMPENSATION OF THE CHIEF EXECUTIVE OFFICER. THIS INCLUDES, BUT IS NOT LIMITED TO, BENCHMARKS OF COMPENSATION FOR SIMILAR ORGANIZATIONS, PROVIDED FROM INDEPENDENT SOURCES. BASED ON THIS INFORMATION AND THE RESULTS OF THE PERFORMANCE EVALUATION, THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS SETS AND APPROVES THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER FOR THE YEAR AND DOCUMENTS THEIR APPROVAL IN WRITING. THIS PROCESS APPLIES ONLY TO THE CHIEF EXECUTIVE OFFICER. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICTS OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO IRC SECTION 6104. THESE DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC ON RECEIPT OF A WRITTEN REQUEST. FORM 990, PART XI, LINE 9: FMV CHANGE IN INTEREST SWAP 28,595. FMV CHANGE IN PERPETUAL TRUST 168,708. CEDAR CREST FOUNDATION INC 1702 SOUTH RIVER ROAD JANESVILLE WI 53546 200703369 ORGANIZATION SUPPORT WI 501(C)(3) LINE 12A, I CEDAR CREST INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1