2021-02-09T11:05:27-06:00 2020-06-30 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2019-07-01 396069188 SHEBOYGAN SENIOR COMMUNITY INC SHEB 9204582137 3505 COUNTY ROAD Y SHEBOYGAN WI 53083 TARA HOLZEM OFFICER 9204582137 2021-02-09 1 KIMBERLY ANDERSON CPA P00188889 6086628600 2021-02-08 2019 2022-09-23 18:48:47Z TARA HOLZEM 3505 COUNTY ROAD Y SHEBOYGAN WI 53083 7700066 0 X WWW.SHEBOYGANSENIORCOMMUNITY.COM 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 11 209 55 0 0 16329 89080 7690907 7609554 688 1432 0 0 7707924 7700066 0 0 0 0 4940863 5019027 0 0 0 2986527 2984222 7927390 8003249 -219466 -303183 16249842 16797072 15291195 16141608 958647 655464 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 6769176 0 7609554 OPERATION OF A FULL-TIME SKILLED NURSING HOME AND RESIDENTIAL CARE CENTER. TOTAL PATIENT DAYS: 28,582. 6769176 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 2 0 1 209 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 0 1 1 1 0 0 WI X TARA HOLZEM 9204582137 3505 CTY RD Y SHEBOYGAN WI 53083 PAUL TREFFERT CEO 39.75 0.25 X 120198 0 10942 TARA HOLZEM BUSINESS OFFICE MANAGER 39.75 0.25 X 68721 0 1401 DAVID VAN DE WATER PRESIDENT 0.50 0.25 X X 0 0 0 PERRY FRITZ VICE PRESIDENT 0.50 0.25 X X 0 0 0 MEG TRAGER SECRETARY 0.50 0.25 X X 0 0 0 ERIC STUART TREASURER 0.50 0.25 X X 0 0 0 CINDY THOMPSON DIRECTOR 0.50 0.25 X 0 0 0 LARRY SAMET DIRECTOR 0.50 0.25 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 188919 0 12343 1 0 0 0 GREENFIELD REHABILITATION AGENCY 19395 W CAPITAL DR BROOKFIELD WI 53045 THERAPY SERVICES 310681 1 8941 80139 89080 SKILLED NURSING FACILI 900099 6015184 6015184 RESIDENTIAL CENTER 623000 1492839 1492839 OTHER SERVICES 900099 60045 60045 INDEPENDENT LIVING 623990 21717 21717 BEAUTY SHOP 812900 19769 19769 7609554 1432 1432 7700066 7609554 0 1432 241472 241472 3801700 3391990 409710 51421 49443 1978 610212 597127 13085 314222 302137 12085 6535 6535 22111 22111 680272 536550 143722 38792 38792 35042 35042 198447 198447 465267 465267 609907 501988 107919 69473 69473 SUPPLIES 656754 656754 DUES AND SUBSCRIPTIONS 103593 103593 BAD DEBT EXPENSE 56403 56403 EMPLOYMENT COSTS 31489 31489 10137 10137 8003249 6769176 1234073 0 416591 211575 185071 1252515 457752 434951 35474 36299 95431 111739 17687171 2937178 15059523 14749993 16249842 16797072 430510 391334 0 137417 13496397 13398169 1364288 2214688 15291195 16141608 X 871742 571691 86905 83773 958647 655464 16249842 16797072 -303183 0 X 0 1 X 1 0 X 497260 39679 21605 16329 89080 663953 5773201 7325061 7235002 7690907 7609554 35633725 6270461 7364740 7256607 7707236 7698634 36297678 15000 15000 257760 425314 773588 869298 2325960 272760 425314 773588 869298 2340960 33956718 658 339 1209 688 1430 4324 658 339 1209 688 1430 4324 107039 79038 186077 6378158 7444117 7257816 7707924 7700064 36488079 0.93060 0.95100 0.00010 0.00020 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - CHANGE IN PRESENT VALUE OF DEVELOPMENT INCENTIVE RECEIVABLE - 2015 AMOUNT: $ 107,039. 2016 AMOUNT: $ 79,038. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 572217 572217 15182215 2047561 13134654 1126036 642258 483778 806703 247359 559344 14749993 DUE TO AFFILIATE 1364288 PPP LOAN 850400 2214688 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 PRIOR TO FILING. THE BUSINESS MANAGER CHECKS FORM 990 WITH INTERNAL REPORTS. 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 IN 2019. 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