2019-11-14T12:44:22-06:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2018-01-01 900506872 EDEN REHABILITATION SUITES AND GREENHOUSE HOMES INC EDEN 9202354653 3151 EDEN COURT OSHKOSH WI 54904 THERESA M BERTRAM PRESIDENT & CEO 9202325228 2019-11-07 1 KIMBERLY ANDERSON P00188889 6086628600 2019-11-07 67.137.57.251 2019-11-07 08:49:05 CS P D96076016A1D85786C0DD27C05D232F375DC2AFE 08598E5CD8BEAEC8C407760E8BF8A64CD65A21BD 2018 2020-03-31 21:24:44Z THERESA M BERTRAM 225 N EAGLE ST OSHKOSH WI 54902 5863817 0 9386 X WWW.MIRAVIDALIVING.COM X 2009 WI NURSING AND REHABILITATION SERVICES TO AGING PERSONS. 10 10 142 16 0 0 17900 0 5991327 5841988 129 4492 20988 17337 6030344 5863817 0 0 0 0 3170121 3179567 0 0 0 3053653 2899636 6223774 6079203 -193430 -215386 9206302 9017839 12870164 12897087 -3663862 -3879248 EDEN REHABILITATION SUITES AND GREENHOUSE HOMES. INC. IS PART OF A FAMILY OF HEALTHCARE AND RESIDENTIAL SERVICE ORGANIZATIONS PROVIDING QUALITY CARE AND LIFE ENRICHING OPPORTUNITIES TO THE AGING AND THOSE IN NEED IN A CARING, CHRISTIAN ENVIRONMENT. 0 0 5419083 5841988 EDEN REHABILITATION SUITES AND GREEN HOUSE HOMES, INC. OPERATES A 50-BED NURSING FACILITY PROVIDING SKILLED AND INTERMEDIATE NURSING CARE FOR THE AGED AND DISABLED OF OSHKOSH AND THE SURROUNDING AREA. THE HOME CONSISTS OF ONE 30 BED REHAB BUILDING AND TWO 10 BED GREEN HOUSE HOMES. 5419083 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 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 0 0 0 1 13 0 1 142 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X KIM MAKI 9202325238 225 NORTH EAGLE STREET OSHKOSH WI 54902 KAREN JACOBSON CHAIR AS OF JUNE 30, 2018 0.20 1.40 X X 0 0 0 MARY MURKEN VICE CHAIR AS OF JUNE 30, 2018 0.20 1.40 X X 0 0 0 LOIS JAENKE SECRETARY AS OF JUNE 30, 2018 0.20 2.90 X X 0 0 0 MARK BEECHER BOARD MEMBER 0.20 2.90 X 0 0 0 KATHY BERMINGHAM BOARD MEMBER 0.20 1.40 X 0 0 0 JAMIE BONELL BOARD MEMBER 0.20 1.40 X 0 0 0 REV JAN LAVAKE BOARD MEMBER 0.20 1.40 X 0 0 0 GLENN NELSON BOARD MEMBER 0.20 1.40 X 0 0 0 PEG OLSON BOARD MEMBER 0.20 1.40 X 0 0 0 STEW RIECKMAN BOARD MEMBER 0.20 1.40 X 0 0 0 KATHLEEN BELLAIRE CHAIR UNTIL JUNE 30, 2018 0.20 1.40 X X 0 0 0 JIM STAPEL SECRETARY UNTIL JUNE 30, 2018 0.20 1.40 X X 0 0 0 DR SUZANNE MARNOCHA BOARD MEMBER 0.20 1.40 X 0 0 0 WAYNE MUELLER BOARD MEMBER 0.20 1.40 X 0 0 0 THERESA BERTRAM PRESIDENT & CEO 4.50 35.50 X 0 376828 0 0 376828 0 0 0 1 0 GREENFIELD REHAB AGENCY 7517 W COLDSPRING RD GREENFIELD WI 53220 THERAPY SERVICES 783254 STAT TEMPORARY SERVICES INC 5800 N BAYSHORE DR SUITE A-220 GLENDALE WI 53217 STAFFING AGENCY 152021 REINHART FOOD SERVICE LLC 2655 EAST RICHMOND ST SHAWANO WI 54166 FOOD SUPPLIER 102954 WI DEPT OF HEALTH SERVICES PO BOX 093594 MILWAUKEE WI 53293 HEALTH SERVICES 102000 4 RESIDENT REVENUE 623990 5841988 5841988 5841988 4492 4492 MEAL REVENUE 900099 9451 9451 MISCELLANEOUS 900099 6099 6099 VACCINE REVENUE 900099 1787 1787 17337 5863817 5841988 0 21829 X 2775905 2357868 418037 63805 54196 9609 188179 159840 28339 151678 128836 22842 258533 258533 929 929 34698 2250 32448 2015 2015 887440 868109 19331 39655 39655 47195 6901 40294 29970 29970 300141 300141 5617 3251 2366 369905 369905 433497 433497 25516 25516 MEDICAL SUPPLIES 321788 321788 0 BED ASSESSMENT 102000 102000 0 MISCELLANEOUS EXPENSE 39070 24437 14633 BAD DEBT 1667 0 1667 6079203 5419083 660120 0 484563 375553 3946 0 350876 669473 9271 13109 28544 34966 11117635 3775284 7752616 7342351 63087 63784 513399 518603 9206302 9017839 429967 473329 8459487 8232987 2896 3224 3977814 4187547 12870164 12897087 X -3663862 -3879248 -3663862 -3879248 9206302 9017839 -215386 0 X 0 1 X 1 0 X 37801 14145 2569 17900 72415 5610989 5776270 5890695 5991327 5841988 29111269 5648790 5790415 5893264 6009227 5841988 29183684 0 3194547 3450801 3642570 3488735 3613738 17390391 3194547 3450801 3642570 3488735 3613738 17390391 11793293 25299 18123 639 129 4492 48682 25299 18123 639 129 4492 48682 11659 5133 22216 20988 17337 77333 5685748 5813671 5916119 6030344 5863817 29309699 0.40240 0.40970 0.00170 0.00290 X 0 1 X 468688 468688 7095994 1420293 5675701 753416 516057 237359 2796693 1838934 957759 2844 2844 7342351 DEBT SERVICE RESERVE 308558 RESIDENT TRUST 7257 BOND FUNDS 202788 518603 DUE TO AFFILIATES 4187547 4187547 X PART IV, LINE 2B: RESIDENT'S CUSTODIAL ACCOUNTS CONSIST OF AMOUNTS ON DEPOSIT WITH EDEN REHABILITATION SUITES AND GREEN HOUSE HOMES, INC. BY RESIDENTS FOR SAFEKEEPING. THESE FUNDS CAN BE WITHDRAWN AT ANY TIME BY RESIDENTS. PART X, LINE 2: THE ORGANIZATION FOLLOWS THE PROVISIONS OF THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THE INCOME TAX STANDARD HAD NO IMPACT ON THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATIONS FILES INFORMATIONAL RETURNS AS A TAX-EXEMPT ORGANIZATION. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. 0 0 0 0 0 0 0 0 0 THERESA BERTRAM PRESIDENT & CEO 0 314828 0 62000 0 0 0 0 0 0 0 376828 0 0 PART I, LINE 3 THE COMPENSATION OF THE PRESIDENT & CEO IS DETERMINED BY THE ORGANIZATION'S SOLE MEMBER, MIRAVIDA LIVING, INC. THE FOLLOWING METHODS WERE USED BY MIRAVIDA LIVING, INC. TO ESTABLISH THE PRESIDENT & CEO'S COMPENSATION: 1. COMPENSATION SURVEY OR STUDY 2. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE A HOUSING AUTHORITY OF THE COUNTY OF WINNEBAGO WISCONSIN 391252334 974611AK1 2015-06-23 9160000 FOR CONSTRUCTION OF EDEN REHABILITATION SUITES AND GREENHOUSE HOMES, INC. 0 0 0 A 1580000 10000000 511346 200000 9058750 2009 0 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD OF DIRECTORS PLUS TWO OTHER MEMEBERS OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL BE RESPONSIBLE FOR THE AGENDA FOR THE BOARD AND VOTING MEMBERSHIP MEETINGS. THIS COMMITTEE SHALL KEEP ITSELF INFORMED OF THE ENTIRE OPERATION OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS, AND SHALL EXECUTE SUCH ACTIONS AS MAY BE ASSIGNED TO IT BY THE BOARD. THE COMMITTEE SHALL ALSO CONCERN ITSELF WITH MATTERS NOT ASSIGNED TO OTHER COMMITTEES. FORM 990, PART VI, SECTION A, LINE 6 MIRAVIDA LIVING, INC. IS THE SOLE MEMBER OF EDEN REHABILITATION SUITES AND GREENHOUSE HOMES, INC. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS OF EDEN REHABILITATION SUITES AND GREENHOUSE HOMES, INC. ARE ELECTED BY THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC. FORM 990, PART VI, SECTION A, LINE 7B MAJOR STANDARD OPERATING PROCEDURES, MAJOR POLICIES, AND PROGRAMS OF EDEN REHABILITATION SUITES AND GREENHOUSE HOMES, INC. ARE SUBMITTED TO THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC. FOR APPROVAL AND IMPLEMENTATION. AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS REQUIRE THE APPROVAL OF THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC. FORM 990, PART VI, SECTION B, LINE 11B BEFORE IT WAS FILED, THE FORM 990 WAS REVIEWED BY THE CEO, THEN DISTRIBUTED TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE CORPORATE SECRETARY DISTRIBUTES A CONFLICT OF INTEREST FORM TO EACH MEMBER OF THE BOARD OF DIRECTORS AND VARIOUS COMMITTEE MEMBERS NOT ON THE BOARD THAT REQUIRES EACH TO IDENTIFY POTENTIAL CONFLICTS OR OTHER RELATED PARTY INTERESTS. THE REPORTS ARE REVIEWED BY THE SECRETARY AND CEO AND ANY CONFLICTS ARE BROUGHT TO THE BOARD'S ATTENTION. A MEMBER OF THE BOARD WHO HAS A CONFLICT OF INTEREST MAY NOT VOTE ON ANY SUCH ISSUE BEFORE THE BOARD. ANY QUESTION OF WHETHER THERE IS A CONFLICT IS RESOLVED BY THE BOARD OF DIRECTORS. IF THE BOARD OF DIRECTORS DETERMINES THAT A DIRECTOR HAS COMMITTED A SUBSTANTIAL VIOLATION OF THE CONFLICT OF INTEREST POLICY, THE INDIVIDUAL IS REMOVED FROM THE OFFICE OF DIRECTOR. IN ADDITION, ALL MANAGEMENT AND SUPERVISORY EMPLOYEES ARE INFORMED OF THE ORGANIZATIONS POLICY REGARDING RELATED PARTY TRANSACTIONS AND CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 CEO COMPENSATION AND BENEFITS ARE REVIEWED ANNUALLY. COMPARABLE INDUSTRY STANDARDS ARE CONSIDERED INCLUDING COMPENSATION AND BENEFIT INFORMATION PROVIDED BY THE LEADINGAGE NATIONAL. DELIBERATIONS INCLUDE A REVIEW OF OBJECTIVES AND ACTUAL DELIVERABLES. DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN A LETTER. COMPENSATION AND BENEFITS FOR OTHER OFFICERS AND KEY EMPLOYEES ARE REVIEWED ANNUALLY BY THE CEO. COMPARABLE INDUSTRY STANDARDS ARE CONSIDERED INCLUDING COMPENSATION AND BENEFIT INFORMATION PROVIDED BY LEADINGAGE WISCONSIN. DELIBERATIONS INCLUDE A REVIEW OF OBJECTIVES AND ACTUAL DELIVERABLES. PROCESS IS DOCUMENTED/MAINTAINED ELECTRONICALLY. THESE PROCESSES LAST OCCURRED IN 2018. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS AVAILABLE UPON REQUEST AND IS ALSO AVAILABLE AT WWW.GUIDESTAR.ORG. THE ORGANIZATION'S FORM 1023 IS ALSO AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G GROUNDS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 47,390. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,390. CONSULTING: PROGRAM SERVICE EXPENSES 8,203. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,203. CONTRACTED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 812,516. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 812,516. CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 19,331. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,331. MIRAVIDA LIVING INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391032234 MANAGEMENT SERVICES WI 501(C)(3) LINE 10 N/A 0 BETHEL HOME INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391209707 SKILLED NURSING FACILITY WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 CARMEL RESIDENCE INC 220 NORTH WESTFIELD STREET OSHKOSH WI 54902 391448325 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 GABRIEL'S VILLA INC 215 NORTH WESTFIELD STREET OSHKOSH WI 54902 391857036 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA APARTMENTS INC 155 NORTH EAGLE STREET OSHKOSH WI 54902 237148097 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA SOUTH INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391238670 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA III INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391270056 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 MIRAVIDA LIVING FOUNDATION INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 010938793 FUNDRAISING WI 501(C)(3) LINE 12A, I MIRAVIDA LIVING INC 0 0 0 1 1 1 0 0 0 0 1 1 0 1 1 1 1 1 0 0