2018-11-13T14:08:07-06:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2017-01-01 900506872 EDEN REHABILITATION SUITES AND GREENHOUSE HOMES INC EDEN 9202354653 3151 EDEN COURT OSHKOSH WI 54904 THERESA M BERTRAM PRESIDENT & CEO 9202325228 2018-11-09 1 KIMBERLY ANDERSON CPA P00188889 6086628600 2018-11-05 67.137.57.251 2018-11-09 09:59:53 CS P 6E90C7C5DAB7B6CE43E299C98BE0892EC7C4F8B9 E6A0C83F9AD34C566D8707BD1B63F824EA830523 2017 2019-02-21 02:37:17Z THERESA M BERTRAM 225 N EAGLE ST OSHKOSH WI 54902 6030344 0 9386 X WWW.MIRAVIDALIVING.COM X 2009 WI NURSING AND REHABILITATION SERVICES TO AGING PERSONS. 10 10 165 16 0 0 2906 17900 5890695 5991327 639 129 21879 20988 5916119 6030344 0 0 0 0 3117422 3170121 0 0 0 3046154 3053653 6163576 6223774 -247457 -193430 9797062 9206302 13267494 12870164 -3470432 -3663862 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 5306944 5991327 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. 5306944 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 1 165 1 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 KATHLEEN BELLAIRE CHAIR AS OF JUNE 30, 2017 0.20 1.40 X X 0 0 0 KAREN JACOBSON VICE CHAIR AS OF JUNE 30, 2017 0.20 1.40 X X 0 0 0 PEG OLSON BOARD MEMBER 0.20 1.40 X 0 0 0 REV JAN VESETH BOARD MEMBER 0.20 1.40 X 0 0 0 MARY MURKEN BOARD MEMBER 0.20 1.40 X 0 0 0 WAYNE MUELLER BOARD MEMBER 0.20 1.40 X 0 0 0 DR SUZANNE MARNOCHA BOARD MEMBER 0.20 1.40 X 0 0 0 JIM STAPEL SECRETARY AS OF JUNE 30, 2017 0.20 1.40 X X 0 0 0 KATHY BERMINGHAM BOARD MEMBER 0.20 1.40 X 0 0 0 LOIS JAENKE BOARD MEMBER 0.20 1.40 X 0 0 0 MARK BEECHER CHAIR UNTIL JUNE 30, 2017 0.20 1.40 X X 0 0 0 THOMAS DUNHAM SECRETARY UNTIL JUNE 30, 2017 0.20 1.40 X X 0 0 0 THERESA BERTRAM PRESIDENT & CEO 4.00 36.00 X 0 324659 0 JULIE VANDENBERG CORPORATE SECRETARY 4.00 36.00 X 0 32740 0 0 357399 0 0 0 1 0 GREENFIELD REHAB AGENCY 7517 W COLDSPRING RD GREENFIELD WI 53220 THERAPY SERVICES 775601 REINHART FOOD SERVICE LLC 2655 EAST RICHMOND ST SHAWANO WI 54166 FOOD SUPPLIER 117564 WI DEPT OF HEALTH SERVICES PO BOX 093594 MILWAUKEE WI 53293 HEALTH SERVICES 102000 3 17900 17900 RESIDENT REVENUE 623990 5991327 5991327 5991327 129 129 MEAL REVENUE 900099 12349 12349 MISCELLANEOUS 900099 8252 8252 VACCINE REVENUE 900099 387 387 20988 6030344 5991327 0 21117 X 2652205 2277875 374330 80104 68798 11306 271045 232790 38255 166767 143230 23537 258528 258528 207 207 40156 2500 37656 1900 1900 888695 879643 9052 37804 37804 46884 10179 36705 20176 20176 330671 330671 2509 1732 777 373629 373629 449281 449281 35522 35522 MEDICAL SUPPLIES 371745 371745 BED ASSESSMENT 102000 102000 BAD DEBT 49992 49992 MAINTENANCE SUPPLIES 285 285 43669 25164 18505 6223774 5306944 916830 0 510888 484563 4000 3946 475518 350876 20767 9271 27464 28544 11102903 3350287 8182882 7752616 63087 63087 512456 513399 9797062 9206302 430360 429967 8680986 8459487 2952 2896 4153196 3977814 13267494 12870164 X -3470432 -3663862 -3470432 -3663862 9797062 9206302 -193430 0 X X 0 1 X 1 0 X 13707 37801 14145 2569 17900 86122 5198264 5610989 5776270 5890695 5991327 28467545 5211971 5648790 5790415 5893264 6009227 28553667 0 3016876 3194547 3450801 3642570 3488735 16793529 3016876 3194547 3450801 3642570 3488735 16793529 11760138 40368 25299 18123 639 129 84558 40368 25299 18123 639 129 84558 4018 11659 5133 22216 20988 64014 5256357 5685748 5813671 5916119 6030344 28702239 0.40970 0.42390 0.00290 0.00620 X 0 1 X 468688 468688 7095994 1252702 5843292 753416 452475 300941 2779825 1645110 1134715 4980 4980 7752616 DEBT SERVICE RESERVE 307006 RESIDENT TRUST 4286 BOND FUNDS 202017 DUE FROM AFFILIATES 90 513399 DUE TO AFFILIATES 3977814 3977814 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'S NINE NONPROFIT CORPORATIONS ARE EXEMPT FROM INCOME TAXES PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THESE ENTITIES ARE NOT PRIVATE FOUNDATIONS, AND CONTRIBUTIONS TO THE ORGANIZATION QUALIFY AS CHARITABLE TAX DEDUCTIONS BY THE CONTRIBUTOR. 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 270000 0 51707 0 2952 0 0 0 0 0 324659 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 1345000 10000000 741250 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 IS DETERMINED BY A COMMITTEE OF THE BOARD OF DIRECTORS. THE COMMITTEE CONSIDERS COMPARABLE DATA AND ECONOMIC CONDITIONS. THE DELIBERATIONS ARE RECORDED. THESE PROCESSES LAST OCCURRED IN 2017. 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 42,333. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 42,333. CONSULTING: PROGRAM SERVICE EXPENSES 5,445. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,445. CONTRACTED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 831,865. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 831,865. CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 9,052. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,052. FORM 990, PART XII, LINE 2C: THE ORGANIZATION'S PROCESSES HAVE NOT CHANGED FROM THE PRIOR YEAR. 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