2017-04-13T15:03:42-05:00 2016-06-30 420714325 RSM US LLP 1252 BELL VALLEY ROAD SUITE 300 ROCKFORD IL 61108 990 2015-07-01 391025444 CEDAR CREST INC CEDA 6087560344 1702 SOUTH RIVER ROAD JANESVILLE WI 53546 DAVID TANCK PRESIDENT/ CEO 6087560344 2017-03-16 1 MICHAEL J SPODEN P00007977 8152317300 2015 2021-01-29 14:40:06Z DAVID TANCK 1702 SOUTH RIVER ROAD JANESVILLE WI 53546 14227502 0 X CEDARCRESTNET.COM X 2003 WI CEDAR CREST IS A CONTINUING CARE RETIREMENT COMMUNITY SERVING ADULTS 55 YEARS OF AGE OR OLDER, ITS MISSION IS TO ENRICH THE QUALITY OF LIFE FOR SENIOR ADULTS AT ALL LEVELS OF INDEPENDENCE, GUIDED BY A SPIRITUALLY BASED, NOT-FOR-PROFIT CULTURE THAT FOSTERS COMPASSION AND CARE. 14 14 286 170 0 0 107450 61808 14488003 14040093 50399 48704 70147 64116 14715999 14214721 0 0 0 0 8204197 8153649 0 0 0 5723396 5924405 13927593 14078054 788406 136667 40752149 40749181 29183116 29018482 11569033 11730699 X SEE SCHEDULE O 0 0 7194545 8168688 SEE SCHEDULE O 2254196 2559415 SEE SCHEDULE O 2078804 2360275 SEE SCHEDULE O 838221 951715 SEE SCHEDULE O 838221 951715 12365766 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 61 0 1 286 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X DAVID TANCK 6087560344 1702 SOUTH RIVER ROAD JANESVILLE WI 53546 BISHOP HEE-SOO JUNG DIRECTOR 1.00 X 0 0 0 CAROL HATCH DIRECTOR 1.00 X 0 0 0 DIANE PILLARD DIRECTOR 1.00 X 0 0 0 GERALD KELM DIRECTOR/CHAIR 1.00 X X 0 0 0 JOEL BAILEY DIRECTOR/SECRETARY 1.00 X X 0 0 0 LAURENCE KACHEL DIRECTOR 1.00 X 0 0 0 MICHAEL DOW DIRECTOR 1.00 X 0 0 0 REV FORREST WELLS DIRECTOR 1.00 X 0 0 0 REV SAM ROYAPPA DIRECTOR 1.00 X 0 0 0 ROBERT DAILEY DIRECTOR 1.00 X 0 0 0 ROBERT DOUGLAS DIRECTOR 1.00 X 0 0 0 TARI MILLER DIRECTOR 1.00 X 0 0 0 THOMAS LASSE DIRECTOR 1.00 X 0 0 0 TOBIN RYAN DIRECTOR 1.00 X 0 0 0 MARION WOZNIAK PRESIDENT/CEO/TREASURER 40.00 X 251535 0 7546 MEREDITH AARUD VICE PRESIDENT 40.00 X 105977 0 22986 357512 0 30532 2 0 1 0 REHAB CARE GROUP PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 933850 PRAIRIE CRAFTMAN INC 839 HARDING STREET JANESVILLE WI 53546 CONSTRUCTION 560466 KLOBUCAR CONSTRUCTION 3140 E CO RD S BELOIT WI 53511 CONSTRUCTION 485418 BRIGHTSTAR 3240 UNIVERSITY AVE STE 3A MADISON WI 53705 TEMPORARY AGENCY 175967 OMNICARE PO BOX 713611 CINCINNATI OH 45271 PHARMACY SERVICES 151587 9 23422 38386 61808 HEALTH CENTER 623990 8168688 8168688 RETIREMENT APARTMENTS 623990 2559415 2559415 ASSISTED LIVING 623990 2360275 2360275 MEMORY CARE 623990 755580 755580 WATERFORD GROVE 623990 186998 186998 9137 9137 14040093 49704 49704 75 1075 -1000 -1000 -1000 8400 23422 11706 -3306 -3306 FMV OF CHANGE IN INTEREST RATE SW 900099 146916 146916 UNREALIZED GAIN/LOSS 900099 -16792 -16792 FMV CHANGE IN PERPETUAL TRUST 900099 -62702 -62702 67422 14214721 14106515 0 46398 357512 312648 44864 6118415 5350611 767804 124380 106627 17753 1107381 949322 158059 445961 382308 63653 5516 5516 75669 75669 549497 471066 78431 23587 23587 42397 36346 6051 608702 521821 86881 16269 16269 500788 500788 1580684 1580684 125610 125610 THERAPY 994824 852831 141993 SUPPLIES 435374 373232 62142 FOOD 378173 378173 MA ASSESSMENT FEES 185640 185640 401675 347400 54275 14078054 12365766 1712288 0 3277411 2765099 3820202 3573565 740653 1002824 231585 523381 51642726 20121008 31244899 31521718 652591 640487 784808 722107 40752149 40749181 2204445 1694075 9209241 10136893 17595000 17160000 174430 27514 29183116 29018482 X 10731427 10991827 26335 16765 811271 722107 11569033 11730699 40752149 40749181 X 136667 25000 X 0 1 X 1 0 X 91997 90513 155635 107452 61808 507405 13268628 13906694 14200822 14488003 14040093 69904240 13360625 13997207 14356457 14595455 14101901 70411645 0 0 0 70411645 67349 46579 47841 50399 49704 261872 322 322 67349 46901 47841 50399 49704 262194 13427974 14044108 14404298 14645854 14151605 70673839 0.99630 0.99460 0.00370 0.00540 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1437400 -35154 39652 1362594 1446532 75 36783 45990 1437400 1310497 177114 41079 1446532 1244110 106875 40488 1310497 1285541 -1280 40151 1244110 0.47000 0.53000 1 0 977257 977257 42423458 16847821 25575637 5616697 2230584 3386113 2625314 1042603 1582711 31521718 INTEREST RATE SWAP LIABILITY 27514 27514 X 14224919 10198 10198 14214721 0 14214721 14078062 9 9 14078053 0 14078053 PART V, LINE 4: ENDOWMENT FUNDS ARE USED TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO INTENDED SERVICES AND PROGRAMS PART X, LINE 2: THE CORPORATIONS ARE EXEMPT FROM INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). ACCORDINGLY, THERE IS NO PROVISION FOR FEDERAL OR STATE INCOME TAXES. THE CORPORATIONS FILE FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH CARE ORGANIZATIONS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX-EXEMPT STATUS OF EACH ENTITY, THE CONTINUED TAX-EXEMPT STATUS OF BONDS ISSUED AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). UBIT IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. FOR THE YEARS ENDED JUNE 30, 2016, 2015, 2014, AND 2013. THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED AND RECORDED AS LIABILITIES. FORMS 990 FILED BY THE CORPORATIONS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. WITH FEW EXCEPTIONS, THE CORPORATIONS ARE NO LONGER SUBJECT TO EXAMINATIONS BY THE IRS FOR TAX YEARS BEFORE 2012. PART XI, LINE 2D - OTHER ADJUSTMENTS: INCOME FROM CEDAR CREST FOUNDATION 10,198. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM CEDAR CREST FOUNDATION 9. GOLF OUTING 31822 23422 8400 296 5473 5937 31822 23422 8400 296 5473 5937 11706 -3306 X X X X 0 0 0 0 0 0 0 0 0 MARION WOZNIAK PRESIDENT/CEO/TREASURER 226535 0 25000 0 0 0 7546 0 0 0 259081 0 0 0 A ADJUSTABLE RATE REFUNDING REVENUE BONDS SERIES 2013 391337855 2013-12-30 18005000 PROVIDE FUNDS TO REFUND A PRIOR ISSUE 0 0 0 A 18005000 63740 1 0 1 1 A 0 0 0 0 1 0 0 A 1 1 1 BMO HARRIS BANK 6.830000000000 0 0 0 0 0 A 0 FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: CEDAR CREST'S MISSION IS TO "ENRICH THE QUALITY OF LIFE FOR SENIOR ADULTS AT ALL LEVELS OF INDEPENDENCE, GUIDED BY A SPIRITUALLY BASED, NOT-FOR-PROFIT CULTURE THAT FOSTERS COMPASSION AND CARE." AS A SPIRTUALLY BASED ORGANIZATION, WE BELIEVE EACH PERSON WHETHER RESIDENT, STAFF, VOLUNTEER, OR NEIGHBOR IS A PRECIOUS GIFT TO BE TREATED WITH RESPECT IN BODY, MIND, AND SPIRIT. WE BELIEVE SENIOR ADULTS DESERVE TO LIVE THEIR FULL LIFE WITH DIGNITY. THEREFORE, WE ARE DEDICATED TO TREATING EACH PERSON WHO LIVES AT CEDAR CREST AS AN IMPORTANT AND UNIQUE INDIVIDUAL AND TO PROVIDE THE SUPPORT NEEDED TO ENHANCE THE LIVES OF OUR RESIDENTS. THROUGH INTEGRITY AND PROFESSIONNALISM, CLEAR AND INCLUSIVE COMMUNICATION, A DIVERSE AND DYNAMIC ARRAY OF LIVING AND SERVICE OPTIONS, A RESPECT FOR INDIVIDUAL EXPERIENCES AND CHOICES, AND A CORPORATE CULTURE OF EXCELLENT CUSTOMER SERVICE, WE STRIVE TO HELP EACH RESIDENT ACHIEVE THE HIGHEST QUALITY OF LIFE POSSIBLE. FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS: CEDAR VIEW IS A SKILLED NURSING FACILITY PROVIDING 24 HOUR COMPLETE CARE OF EACH RESIDENT INCLUDING BUT NOT LIMITED TO: FEEDING, THREE MEALS PER DAY PLUS SNACKS BASED ON INDIVIDUAL DIET NEEDS, NUTRITION MANAGEMENT, BATHING AND DRESSING, LAUNDRY, HOUSEKEEPING, TOILETING, MEDICATIONS ADMINISTRATION AND MANAGEMENT, DRESSING CHANGES, RESTORATIVE PROGRAM BASED ON THE INDIVIDUAL RESIDENT'S NEEDS, REHABILITATION SERVICES INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, ACTIVITIES MEETING THE INDIVIDUAL NEEDS OF EACH RESIDENT, TUBE FEEDING, DEVELOPMENT OF AND IMPLEMENTING FOR EACH RESIDENT A COMPLETE INDIVIDUAL CARE PLAN, SCHEDULING OF MEDICAL APPOINTMENTS, TRANSPORTATION TO MEDICAL APPOINTMENTS, COORDINATING CARE UNDER THE DIRECTION OF THE RESIDENT'S DOCTOR. THE PROGRAM IS LICENSED AS A 83 BED SKILLED NURSING FACILITY. THE PROGRAM IS MEDICARE AND MEDICAID CERTIFIED AND PROVIDES SERVICES TO RESIDENTS WHO PAY PRIVATELY AS WELL AS THOSE RESIDENTS WHO ARE ENTITLED TO MEDICARE AND MEDICAID BENEFITS. A TOTAL OF 28,635 RESIDENT CARE DAYS WERE PROVIDED. FORM 990, PART III, LINE 4B, PROGRAM SERVICE ACCOMPLISHMENTS: WATERFORD PLACE APARTMENTS ARE REGISTERED WITH THE STATE OF WISCONSIN AS A RESIDENTIAL CARE APARTMENT COMPLEX (RCAC). THIS LICENSURE ALLOWS RESIDENTS WHO HAVE CHOSEN AN INDEPENDENT LIVING SETTING WITHIN THE CEDAR CREST COMMUNITY TO "AGE IN PLACE" THROUGH THE PROVISION OF SERVICES IN THEIR APARTMENT. THE SERVICES PROVIDE FOR UP TO 28 HOURS OF NURSING AND PERSONAL CARE SERVICES ARE SCHEDULED AND ARE BASED ON NURSING ASSESSMENT AND RISK AGREEMENT BETWEEN THE RESIDENT AND CEDAR CREST. THERE ARE 107 APARTMENTS UNDER THE RCAC REGISTRATION WITH APPROXIMATELY 31,731 DAYS OF SERVICE BEING PROVIDED TO THE RESIDENTS. FORM 990, PART III, LINE 4C, PROGRAM SERVICE ACCOMPLISHMENTS: TERRACE RIDGE ASSISTED LIVING IS A 44 BED COMMUNITY BASED ON RESIDENTIAL FACILITY (CBRF) WHICH IS LICENSED BY THE STATE OF WISCONSIN. THE PROGRAM PROVIDES SERVICES TO RESIDENTS WHO REQUIRE LIMITED NURSING CARE BUT NEED VARYING LEVELS OF ASSISTANCE WITH DAILY LIVING ACTIVITIES. THE PROGRAM IS STAFFED 24 HOURS PER DAY, SEVEN DAYS A WEEK WITH PERSONAL CARE WORKERS AND CERTIFIED NURSING ASSISTANTS. IT IS ALSO STAFFED WITH A FULL TIME RN ASSISTED LIVING MANAGER. UP TO 3 HOURS OF NURSING CARE PER WEEK IS PROVIDED (DIRECTLY BY AN RN) AND UNLIMITED NUMBER OF HOURS OF CARE WITH DAILY LIVING ACTIVITIES. THIS CARE INCLUDES BATHING AND DRESSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, ACTIVITIES MEETING THE NEEDS OF EACH RESIDENT, FEEDING, THREE MEALS PER DAY AND OTHER NUTRITIONAL NEEDS BASED ON THE INDIVIDUAL RESIDENT, LAUNDRY, HOUSEKEEPING, TOILETING, DRESSING CHANGES, MEDICATION ADMINISTRATION AND MANAGEMENT, SCHEDULING OF MEDICAL APPOINTMENTS, TRANSPORTATION TO MEDICAL APPOINTMENTS, COORDINATING CARE UNDER THE DIRECTION OF THE RESIDENT'S DOCTOR AS WELL AS OTHER UNIQUE NEEDS OF EACH INDIVIDUAL RESIDENT. A TOTAL OF 15,292 RESIDENT CARE DAYS WERE PROVIDED. FORM 990, PART III, LINE 4D, OTHER PROGRAM SERVICES: THE CEDAR CREST MEMORY CARE UNIT IS A 12 BED LICENSED CBRF PROVIDING SERVICES TO THOSE INDIVIDUALS WHO HAVE BEEN DIAGNOSED WITH ALZHEIMER OR OTHER DEMENTIA RELATED DISEASES. THE PROGRAM PROVIDES SERVICES TO RESIDENTS WHO REQUIRE LIMITED NURSING CARE BUT NEED ASSISTANCE WITH DAILY LIVING ACTIVITIES. THE PROGRAM IS STAFFED 24 HOURS PER DAY, SEVEN DAYS A WEEK WITH PERSONAL CARE WORKERS AND CERTIFIED NURSING ASSISTANTS. IT IS ALSO STAFFED WITH AN RN MEMORY CARE MANAGER. UP TO 3 HOURS OF NURSING CARE PER WEEK IS PROVIDED (DIRECTLY BY AN RN) AND UNLIMITED NUMBER OF HOURS OF CARE WITH DAILY LIVING ACTIVITIES. THIS CARE INCLUDES BATHING AND DRESSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, ACTIVITIES MEETING THE NEEDS OF EACH RESIDENT, FEEDING, THREE MEALS PER DAY AND OTHER NUTRITIONAL NEEDS BASED ON THE INDIVIDUAL RESIDENT, LAUNDRY, HOUSEKEEPING, TOILETING, DRESSING CHANGES, MEDICATION ADMINISTRATION AND MANAGEMENT, SCHEDULING OF MEDICAL APPOINTMENTS, TRANSPORTATION TO MEDICAL APPOINTMENTS, COORDINATING CARE UNDER THE DIRECTION OF THE RESIDENT'S DOCTOR AS WELL AS OTHER UNIQUE NEEDS OF EACH INDIVIDUAL RESIDENT. A TOTAL OF 4,304 RESIDENT CARE DAYS WERE PROVIDED. FORM 990, PART VI, SECTION B, LINE 11 THE AUDIT COMMITTEE REVIEWS THE FORM 990 IN DETAIL WITH MANAGEMENT PRIOR TO FILING THE 990. SUBSEQUENT TO THE FILING, THE 990 IS REVIEWED WITH THE FULL BOARD AND COPIES OF THE 990 ARE MADE AVAILABLE TO EACH BOARD MEMBER. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED WITH EACH NEW BOARD MEMEBER AND THE NEW BOARD MEMBER SIGNS A CONFLICT OF INTEREST STATEMENT BEFORE ATTENDING THE FIRST BOARD MEETING. ANNUALLY THE CONFLICT OF INTEREST POLICY IS REVIEWED WITH ALL BOARD MEMBERS AND MANAGERS AND AN UNDATED CONFLICT OF INTEREST STATEMENT IS REQUIRED TO BE COMPLETED BY ALL BOARD MEMBERS AND MANAGERS. THE CONFLICT OF INTEREST STATEMENTS ARE SUMMARIZED AND REVIEWED BY THE GOVERNANCE COMMITTEE AND ANY CONFLICTS ARE REPORTED TO THE BOARD OF DIRECTORS BY THE GOVERNANCE COMMITTEE. IF A CONFLICT OF INTEREST IS DISCOVERED THAT WAS NOT DISCLOSED ON THE CONFLICT OF INTEREST STATEMENT, THE ISSUE IS DIRECTED TO THE GOVERNANCE COMMITTEE FOR RESOLUTION. FORM 990, PART VI, SECTION B, LINE 15 EACH YEAR THE EXECUTIVE COMMITTEE GATHERS MARKET DATA FOR DETERMINING COMPENSATION OF THE CHIEF EXECUTIVE OFFICER. THIS INCLUDES, BUT IS NOT LIMITED TO, BENCHMARKS OF COMPENSATION FOR SIMILAR ORGANIZATIONS, PROVIDED FROM INDEPENDENT SOURCES. BASED ON THIS INFORMATION AND THE RESULTS OF THE PERFORMANCE EVALUATION, THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS SETS AND APPROVES THE COMENSATION FOR THE CHIEF EXECUTIVE OFFICER FOR THE YEAR AND DOCUMENTS THEIR APPROVAL IN WRITING. THIS PROCESS APPLIES ONLY TO THE CHIEF EXECUTIVE OFFICER. CEDAR CREST HAS NO OTHER OFFICERS OR KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICTS OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO IRC SECTION 6104. THESE DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC ON RECEIPT OF A WRITTEN REQUEST. FORM 990, PART XI, LINE 9: RELATED PARTY DUE TO/FROM 25,000. CEDAR CREST FOUNDATION INC 1702 SOUTH RIVER ROAD JANESVILLE WI 53546 200703369 ORGANIZATION SUPPORT WI 501(C)(3) LINE 11A, I CEDAR CREST INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0