2021-10-12T16:47:05-05:00 2020-12-31 390974031 WEGNER CPAS LLP 2921 LANDMARK PL STE 300 MADISON WI 537134236 990 2020-01-01 391195540 CREATIVE COMMUNITY LIVING SERVICES INC CREA 8002362257 314 EAST MAIN STREET WATERTOWN WI 53094 JIM ZACHE CHIEF EXECUTIVE OFFICER 8002362257 2021-10-12 1 JIM ZACHE 999009999 GLENN MILLER CPA P00086726 6082744020 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z JIM ZACHE 314 EAST MAIN STREET WATERTOWN WI 53094 18010333 0 X CCLSWI.ORG X 1973 WI CREATIVE COMMUNITY LIVING SERVICES IS A PROVIDER OF SERVICES AND SUPPORTS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES, MENTAL ILLNESS, PHYSICAL DISABILITIES, OR FUNCTIONAL LIMITATIONS OF ADVANCED AGING. OUR COMMUINITY SUPPORTS ARE INDIVIDUALIZED AND PERSON-CENTERED. WE WORK WITH THE INDIVIDUAL TO BUILD THE NECESSARY SUPPORTS BASED ON THEIR NEEDS, STRENGTHS, AND WISHES. 7 4 723 4 817703 0 122031 1607815 17639797 15557095 11736 21340 372582 821190 18146146 18007440 0 0 0 0 13699823 12998347 0 0 91005 4060576 4312543 17760399 17310890 385747 696550 3917555 7254591 3201880 6033232 715675 1221359 OUR MISSION IS TO ESTABLISH INDIVIDUALIZED COMMUNITY SUPPORTS THAT WILL PRESERVE AND ENHANCE THE DIGNITY AND RIGHTS OF THOSE WHO RELY ON OTHERS WHILE SEEKING THEIR OWN LEVEL OF INDEPENDENCE. 0 0 10190237 0 12718555 DEVELOPMENTALLY DISABLED CARE - PROVIDING RESIDENTIAL HOUSING AND NONRESIDENTIAL SERVICES AND SUPPORTS FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES, MENTAL ILLNESS, PHYSICAL DISABILITIES AND/OR TRAUMATIC BRAIN INJURIES. SERVICES INCLUDE COMMUNITY SUPPORTED LIVING, SUPPORTIVE HOME CARE, SKILLS TEACHING/TRAINING, INDEPENDENT LIVING PROGRAMS, RESPITE, NON-MEDICAL TRANSPORTATION, SUPPORTED EMPLOYMENT, AND PRE-VOCATION, RECREATIONAL, NURSE AND DAY SERVICES. ALL SERVICES AND SUPPORTS ARE INDIVIDUALIZED AND PERSON-CENTERED AND DESIGNED TO PRESERVE AND ENHANCE THE DIGNITY AND RIGHTS OF THOSE WHO RELY ON OTHERS WHILE SEEKING THEIR OWN LEVEL OF INDEPENDENCE. 2136644 0 2838540 ELDER CARE - PROVIDING RESIDENTIAL HOUSING AND SUPPORTS FOR INDIVIDUALS WITH FUNCTIONAL LIMITATIONS OF ADVANCED AGING. SERVICES INCLUDE COMMUNITY SUPPORTED LIVING, SKILLS RE-TEACHING/RE-TRAINING, NON-MEDICAL TRANSPORTATION, AND NURSE. ALL SERVICES AND SUPPORTS ARE INDIVIDUALIZED AND PERSON-CENTERED AND DESIGNED TO PRESERVE AND ENHANCE THE DIGNITY AND RIGHTS OF THOSE WHO RELY ON OTHERS WHILE SEEKING THEIR OWN LEVEL OF INDEPENDENCE. 12326881 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 68 0 723 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 4 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 WI X DWAN SCHUCK 8002362257 314 EAST MAIN STREET WATERTOWN WI 53094 RANDY RADTKE CHAIR 1.00 1.00 X X 1100 0 0 DAVID MORSTAD VICE CHAIR 1.00 1.00 X X 1100 0 0 KAREN FOELKER SECRETARY 1.00 1.00 X X 1250 0 0 ELLEN HAINES DIRECTOR 1.00 1.00 X 1000 0 0 BARB LEDUC DIRECTOR 1.00 1.00 X 1300 0 0 SHERI BERG DIRECTOR 1.00 1.00 X 1150 0 0 DEAN SANDERS DIRECTOR 1.00 1.00 X 300 0 0 JIM ZACHE CHIEF EXECUTIVE OFFICER 34.00 6.00 X 175224 0 8393 DWAN SCHUCK CHIEF FINANCIAL OFFICER 31.00 1.00 X 99770 0 543 SHERRY MARSHALL VICE PRESIDENT OF HUMAN RESOURCES 34.00 6.00 X 104240 0 9035 386434 0 17971 2 0 1 0 0 1571950 35865 1607815 CONTRACT CLIENT SERVICES 624100 15054811 15054811 TRAINING 611430 260118 260118 PRIVATE PAY 624100 242166 242166 15557095 3130 3130 6380 2893 3487 3487 3487 18210 0 18210 18210 18210 RESIDENTIAL MANAGEMENT FEES 623990 817703 817703 817703 18007440 15557095 817703 24827 291130 291130 10295809 7516858 2723603 55348 26295 18670 7488 137 1583462 1124278 450906 8278 801651 569182 228278 4191 11910 11910 41034 41034 563510 535151 28359 438715 246926 184524 7265 234395 124290 109560 545 1919952 1389216 518257 12479 247241 205773 41412 56 5440 1890 3550 47371 2501 44870 117712 83147 34565 152109 69490 82619 FOOD 416070 414471 1599 DUES, FEES, SUBSCRIPTIO 88978 15272 71000 2706 BAD DEBT EXPENSE 13753 13753 14353 9766 4587 17310890 12326881 4893004 91005 138186 2898911 484231 473130 546553 1373921 1488573 184805 32524 3914058 2428635 1603797 1485423 132615 329477 3917555 7254591 1130191 1235032 1709815 1491514 0 2685000 361874 621686 3201880 6033232 X 613015 1100863 102660 120496 715675 1221359 3917555 7254591 X 696550 -190866 X 0 1 X 1 1 1 X 2400 122031 1607815 1732246 19592594 17639797 15557095 52789486 19594994 17761828 17164910 54521732 0 0 0 54521732 3325 6299 9510 19134 3325 6299 9510 19134 19598319 17768127 17174420 54540866 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 300717 300717 2040788 1035242 1005546 1077404 899892 177512 495149 493501 1648 1485423 DUE TO FAST PACE MEDICAL STAFFING, INC. 14198 DEFICIENCY IN ASSETS OF SUBSIDIARY 224991 CAPITAL LEASE OBLIGATION 182014 PROVISION FOR CONTRACT REPAYMENTS 200483 621686 X X 0 0 0 0 0 0 0 0 0 JIM ZACHE CHIEF EXECUTIVE OFFICER 159994 0 15230 0 0 0 800 0 7593 0 183617 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B CCLS HIRES A CPA FIRM TO COMPILE FORM 990. THE CFO AND CEO REVIEW FOR ACCURACY BEFORE SIGNATURE AND SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY ALL DIRECTORS AND OFFICERS COMPLETE AND SIGN A STATEMENT THAT PROVIDES INFORMATION REGARDING THEIR INTERESTS AND THOSE OF THEIR FAMILY MEMBERS THAT COULD GIVE RISE TO CONFLICTS. THE MEMBERS OF THE GOVERNING BODY MAKE DETERMINATIONS OF WHETHER A CONFLICT EXISTS AND REVIEW ACTUAL CONFLICTS. ANY PERSON WITH A CONFLICT IS PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS IN THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 MARKET DATA ANALYSIS FOR SIMILAR INDUSTRIES/CPA FIRM INPUT. HUMAN RESOURCES, CEO, AND REGIONAL DIRECTOR DISCUSS AND DECIDE AFTER 1ST AND 2ND PANEL INTERVIEWS (AND RECOMMENDATIONS) WHAT TO OFFER. INTERVIEW PANEL OFTEN INCLUDES A BOARD MEMBER. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY IN NET LOSS OF FAST PACE MEDICAL STAFFING, INC. -190,866. FAST PACE MEDICAL STAFFING INC 314 EAST MAIN STREET WATERTOWN WI 53094 842704067 TEMPORARY STAFFING WI CREATIVE COMMUNITY LIVING SERVICES INC C 742433 79415 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 FAST PACE MEDICAL STAFFING INC M 336318 FACE AMOUNT