2018-03-09T18:28:25-06:00 2017-06-30 390758449 Wipfli LLP 10000 Innovation Drive Suite 250 Milwaukee WI 532264837 990 2016-07-01 390928211 Benevolent Corporation Cedar Community BENE 2623062100 5595 HWY Z WEST BEND WI 53095 Christopher Cherney cFO 2623062100 2018-02-23 1 Kristina M Odermann CPA P01246844 4144319300 2018-02-06 207.250.78.130 2018-02-23 15:25:35 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D482E504488B33FE332F9841DC0BE60818D7B9FD 2016 2021-01-29 14:40:06Z Lynn W Olson 5595 HWY Z WEST BEND WI 53095 58255412 0 X www.cedarcommunity.org X 1953 WI To operate homes and services for the aged or convalescents, nursing homes, schools & religious institutes or retreats. Our Mission To model Christ's love for humanity by creating life-enhancing relationships, services and environments. 8 8 871 441 0 0 1504682 1202990 46091722 42674534 -241248 935616 0 0 47355156 44813140 0 0 0 0 26853305 26467049 0 0 209061 20471505 20004797 47324810 46471846 30346 -1658706 89264965 86091029 70840918 67297692 18424047 18793337 X Cedar Community is a faith-based organization dedicated to modeling Christ's love for huumanity by creating life-enhancing relationships, services, and environments through the provision of a 155 bed skilled nursing facility providing long term and subacute care with 55% of residents funded through Medicaid and 30% through Medicare and Medicare Replacement Insurance, rehab therapies, home health and hospice services(primarily Medicare), in-home supportive care, retreat facilities, community education, 172 units of assisted living with 52 funded through Family Care, 60 CBRF units specializing in dementia care, 3 communities of independent living providing a total of 414 units, and Bible camp/recreational programs. A variety of ancillary services support these programs including gift shops, dining services, pharmacy, provision of health & personal supplies, activities & entertainment. 0 0 20749909 0 19204382 Cedar Community provides skilled nursing services for residents with healthcare needs, including dementia specific care, subacute care, and supportive services such as pharmacy, therapies, activities, dining services, social & religious services. Cedar Community served 663 individuals during the year. 10476406 0 11481148 Cedar Community provides assisted living services in two locations, with 172 units in residential care apartment complex facilities and 60 units in community based residential facilities. It provides a secure environment, dining services, activites, nursing support, social & religious services. Cedar Community provided services during the year to 327 individuals. 6706788 0 7148558 Cedar Community provides secure retirement living for seniors at 3 locations providing both apartments and individual homes. Ancillary services include a variety of activities, dining services, and access to basic supplies through a gift shop & store. Cedar Community provided independent living services to 608 individuals during the year. 5034029 0 4840446 Cedar Community provides home based services including Hospice, Home Health, and Supportive Care. 5034029 0 4840446 42967132 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 89 0 1 871 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X Christopher Cherney 2623062100 5595 Hwy Z West Bend WI 53095 Robert Fremder Board Member (Thru 6/29/17) 1.00 0.00 X 0 0 0 Julie Gabelmann Board Member 1.00 0.00 X 0 0 0 Dan Miller Board Member 1.00 0.00 X 0 0 0 Bill Myers Jr Board Member 1.00 0.00 X 0 0 0 Jim Riehle Board Member (Thru 6/29/17) 1.00 0.00 X 0 0 0 Tom Ross Board Member 1.00 1.00 X 0 0 0 Heidi Thomas Board Member (Thru 6/29/17) 1.00 1.00 X 0 0 0 Bud Wendorf Board Member 1.00 0.00 X 0 0 0 Joan Adler President 1.00 1.00 X X 0 0 0 Kathy Van Eerden Vice President 1.00 0.00 X X 0 0 0 John Smithers Secretary 1.00 1.00 X X 0 0 0 James Wesson Treasurer (Thru 6/29/17) 1.00 0.00 X X 0 0 0 Lynn Olson CEO 40.00 1.00 X 286605 0 17265 Christopher Cherney CFO 40.00 0.00 X 143247 0 23842 Mark Selle Pharmacy Director 40.00 0.00 X 132070 0 28244 Kelli DeRuyter Administrator 40.00 0.00 X 103846 0 32330 Mark Chapman Director Info Tech 40.00 0.00 X 102544 0 21281 John Kraak Pharmacist 40.00 0.00 X 102760 0 12332 Samuel Vang Pharmacist 40.00 0.00 X 129930 0 1102 1001002 0 136396 7 0 1 0 BSG Maintenance Inc PO Box 165 Newburg WI 53060 Housekeeping Services 1521633 Meridian IT Inc PO Box 33950 Chicago IL 60694 Information Technology Services 490190 Omnicare Inc PO Box 78000 Detroit MI 48278 Pharmacy Services - IV Therapy 206364 AM Construction Inc 2330 Stonebridge CR Unit G West Bend WI 53095 Construction 158041 JNL Technologies W 1205 Industrial Drive Ixonia WI 53036 Information Technology Services 134496 7 1165840 37150 1202990 Health and Rehabilitation 623000 16932866 16932866 Assisted Living 623000 11535461 11535461 Independent Living 623000 5743219 5743219 Ancillary Services 623000 4680299 4680299 Home Based Services 623000 2749711 2749711 1032978 1032978 42674534 368511 368511 10882490 3126887 10883547 2558725 -1057 568162 567105 567105 44813140 42674534 0 935616 457728 457728 20686402 19509981 1081493 94928 407191 382084 23248 1859 3435062 3209948 209496 15618 1480666 1369000 105005 6661 151514 140087 10745 682 142280 131550 10090 640 58734 54305 4165 264 67804 62691 4808 305 3047757 2817908 216138 13711 120191 111126 8524 541 6446865 5960669 457194 29002 1602492 1481639 113644 7209 112264 103798 7961 505 15247 14097 1081 69 1452147 1342632 102982 6533 5765936 5331093 408904 25939 435799 402933 30906 1960 Bed Tax Assessment 403920 373458 28645 1817 Bad debt 181847 168133 12896 818 46471846 42967132 3295653 209061 3776952 3511787 6541000 4679898 2545995 2221159 458827 322784 601567 658891 140262405 84059367 61474594 56203038 12811312 17947698 1054718 545774 89264965 86091029 4662384 3889726 7157933 6843845 28401458 26936827 30619143 29627294 70840918 67297692 X 18424047 18793337 18424047 18793337 89264965 86091029 X -1658706 544448 1483548 X 0 1 X 1 0 X 2856175 3797020 2136612 1504682 1202990 11497479 43020605 44721611 45251652 46091722 42674534 221760124 21402 61253 82655 45876780 48540033 47449517 47596404 43877524 233340258 0 0 0 233340258 489992 308859 235644 236949 368511 1639955 489992 308859 235644 236949 368511 1639955 1576 1576 46368348 48848892 47685161 47833353 44246035 234981789 0.99300 0.99270 0.00700 0.00720 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3235505 3235505 73752533 42550245 31202288 31637265 20204506 11432759 29858859 20745419 9113440 1778243 559197 1219046 56203038 Resident Funds Held in Trust 10637 Entrance Fee Deposits 669223 Obligations under Interest Rate Swap Accounts 2688543 Refundable Entrance Fees 26258891 29627294 46773332 544448 1483548 2027996 44745336 67804 67804 44813140 46404042 0 46404042 67804 67804 46471846 Part XI, Line 2d - Other Adjustments: Change in fair value of interest rate swap 1,483,548. X X X 0 0 0 0 0 0 0 0 0 Lynn Olson CEO 261605 0 25000 0 0 0 0 0 17265 0 303870 0 0 0 Christopher Cherney CFO 143247 0 0 0 0 0 5957 0 17885 0 167089 0 0 0 Mark Selle Pharmacy Director 131970 0 100 0 0 0 5647 0 22597 0 160314 0 0 0 A Wisconsin Health and Educational Facilities Authority 391337855 97710V3U0 2007-06-28 31875000 See Schedule K Supplement 0 0 0 B Wisconsin Health and Educational Facilities Authority 391337855 2013-12-24 4000000 Construction Assisted Care Facility 0 0 0 A 8185000 31875000 222216 7641936 24010848 2008 1 0 1 1 B 454539 4000000 4000000 2013 0 0 1 1 A 0 0 0 0 0.00200 0.00000 0.00200 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 1 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 Date Rebate Computation Performed Issuer Name: Wisconsin Health and Educational Facilities Authority Date the Rebate Computation was Performed: 06/16/2017 Form 990, Schedule K, Part 1, Column F Purpose - refund 2002 A&B series; reimburse leasehold improvements on skilled nursing facility; finance construction of assisted living and senior living facilities; pay certain cost of issuance. Form 990, Part VI, Section B, line 11b The 990 is reviewed by the finance committee and provided to all board members for review and comment before filing with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c Each board member signs a conflict of interest policy statement upon being seated as a member of the board. Annually, all members and Key Employees complete and sign a questionnaire designed to identify areas of potential conflict of interest. Officers of the board ensure that board members abstain from voting on any issue where there is a conflict of interest. CFO ensures that key employees do not make decisions which would place them in a conflict of interest position. Form 990, Part VI, Section B, line 15 Compensation for the Administrative Council is determined annually by the Board Compensation Committee. All other Key employees have salaries set by Administration within ranges established by Human Resources. Both Human Resources and the Board Compensation Committee set rates and ranges with consideration to comparable positions within the area and the industry. Form 990, Part VI, Section C, line 19 May be viewed at Corporate Offices. Form 990, Part XI, line 9: Change in fair value of Swap 1,483,548. Cedar Community Foundation Inc 5595 County Road Z West Bend WI 53095 391249432 To support Benevolent Corporation Cedar Community WI 501(c)(3) Line 12a, I Benevolent Corporation Cedar Community 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 Cedar Community Foundation Inc C 1165840 FMV