2017-08-02T16:12:23-05:00 2016-12-31 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PKWY/PO BOX 690 EAU CLAIRE WI 547020690 990 2016-01-01 912052713 CHRISTIAN COMMUNITY HOMES AND SERVICES GROUP RETURN CHRI 7153869303 1320 WISCONSIN STREET HUDSON WI 54016 Dan Goodier Executive Director 7153869303 2017-08-01 1 HOLLY POKRANDT CPA P00449155 7158323407 2017-08-01 216.54.158.3 2017-08-01 12:45:35 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 BBF7AF8D8805E5377188B18F18D26057C0F4C16D 2016 2021-01-29 14:40:06Z Dan Goodier 1320 WISCONSIN STREET HUDSON WI 54016 15442601 1 1 3557 X www.cchhudson.org X 1994 WI The mission of Christian Community Homes and Services, a church-sponsored organization, is to serve the residents of the campus, and extended community, in a loving and caring environment. We are dedicated to helping to meet their physical, social, emotional, and spiritual needs, and to encourage a sense of dignity and individuality. 13 13 397 220 266541 0 40454 54223 15370617 15342631 8262 7830 17253 21151 15436586 15425835 0 0 0 0 8079138 8284325 0 0 0 6984878 7058749 15064016 15343074 372570 82761 21253419 20886977 19052724 18991729 2200695 1895248 X The mission of Christian Community Homes and Services, a church-sponsored organization, is to serve the residents of the campus, and extended community, in a loving and caring environment. We are dedicated to helping to meet their physical, social, emotional, and spiritual needs, and to encourage a sense of dignity and individuality. 0 0 13437784 15039219 CHRISTIAN COMMUNITY HOME OF HUDSON, INC. IS AN 81-BED NURSING HOME (CCH-HUDSON), A 38-UNIT COMMUNITY BASED RESIDENTIAL FACILITY (PINE RIDGE), AND A 92-UNIT APARTMENT COMPLEX WHICH INCLUDES A 40-UNIT RESIDENTIAL CARE APARTMENT COMPLEX (WINTERGREEN). CHRISTIAN COMMUNITY HOME OF OSCEOLA, INC. IS A 40-BED NURSING HOME (CCH-OSCEOLA) AND A 20-UNIT COMMUNITY BASED RESIDENTIAL FACILITY (HEARTHSIDE).HEALTH CARE SERVICES TO MEDICAID NURSING HOME RESIDENTS ARE CONSIDERED PART OF THE ORGANIZATION'S BENEFIT PROVIDED TO THE COMMUNITY SINCE A SUBSTANTIAL PORTION OF SUCH SERVICES ARE REIMBURSED AT AMOUNTS LESS THAN THE COSTS OF PROVIDING CARE. FOR 2016, CCH-HUDSON'S TOTAL NURSING HOME RESIDENT DAYS WERE 21,320 INCLUDED IN THIS TOTAL WAS 10,591 DAYS FOR RESIDENTS COVERED UNDER THE MEDICAID/HOSPICE MEDICAID PROGRAM. CCH-OSCEOLA'S TOTAL NURSING HOME RESIDENT DAYS WERE 13,215, AND INCLUDED IN THIS TOTAL WAS 6,857 COVERED UNDER THE MEDICAID/HOSPICE MEDICAID PROGRAM.THE NURSING HOME OFFERS SKILLED NURSING CARE IN BOTH SHORT-TERM REHABILITATION PROGRAMS AND LONG-TERM CARE RESIDENT PROGRAMS. SOME OF THE SPECIALIZED CARE SERVICES OFFERED INCLUDE WOUND CARE, PAIN MANAGEMENT, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY.Pine Ridge offers monitored care plans to residents giving them the comfort of knowing that additional care is available as they need it. Services offered at Pine Ridge include housekeeping, laundry, nursing assistance with activities of daily living, dietary services, medication management, and other nursing supervision and care services. Total resident days for 2016 were 13,724. Additionally, Hearthside had 6,898 resident days for 2016.Wintergreen provides elderly and handicapped persons with housing facilities and services available to meet their needs. Among the many services provided are 24-hour on-site staff, assistance with medications, monthly or weekly vital checks, quarterly and annual nursing assessments, transportation services, and assistance with daily cares. Total rental days at Wintergreen Apartments for 2016 were 32,765. 13437784 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 0 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 0 0 0 1 X 56 0 397 1 1 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 0 1 1 1 0 WI MN X Dan Goodier 7153869303 1320 WISCONSIN STREET HUDSON WI 54016 X Arvid Ledin President 1.00 X X 0 0 0 Jeff Maki Vice president/secretary 1.00 X X 0 0 0 Ron Langness Treasurer 1.00 X X 0 0 0 Kathleen Anderson memBER 1.00 X 0 0 0 Judy Freund memBER 1.00 X 0 0 0 Gery Campbell memBER 1.00 X 0 0 0 Mel Hermansen memBER 1.00 X 0 0 0 Carla Bebault memBER 1.00 X 0 0 0 Marian Webber memBER 1.00 X 0 0 0 Rick Hagar memBER 1.00 X 0 0 0 Ruth Knapp memBER 1.00 X 0 0 0 Tom Redding memBER 1.00 X 0 0 0 REv Dr Dawn Jeffers Ramstad memBER 1.00 X 0 0 0 DAN GOODIER Executive Director 40.00 X 235338 0 20344 Mary Eells Director of Operations 40.00 X 103704 0 6237 339042 0 26581 2 0 1 0 Rehab care Group Inc PO Box 50534 st louis MO 63150 Therapy Services 1047360 1 700 53523 54223 Nursing Home 623000 10446939 10446939 assisted living 623990 4536435 4536435 CAFETERIA & VENDING 623000 297917 266541 31376 SENIOR NUTRITION PROGRAMS 624210 61340 61340 15342631 13325 13325 5500 0 5500 5500 5500 2000 7495 -5495 -5495 -5495 24922 700 9271 15651 15651 15425835 15039219 266541 65852 X 457434 457434 6649198 6013856 635342 97574 88251 9323 563257 509437 53820 516862 439027 77835 10413 10413 67421 67421 1626813 1584668 42145 90261 90261 415377 193258 222119 60065 60065 1356510 1356510 36730 36730 1224233 1224233 113812 113812 UNRELATED BUSINESS INCO 3300 3300 Dietary Supplies 775694 775694 Medical Supplies 565973 565973 REPAIRS/MAINT 310530 310530 401617 376347 25270 15343074 13437784 1905290 0 2161434 2451019 104033 125132 937983 944661 122026 95217 32182749 17139189 15829648 15043560 2098295 2227388 0 0 21253419 20886977 781956 872303 6755101 6578818 11217832 11232248 52384 0 245451 308360 19052724 18991729 X 2200695 1895248 2200695 1895248 21253419 20886977 X 82761 8534 -396742 X X 0 1 X 1 0 X Schedule A, Part I, Line 3: LINE 3 OF PART I OF SCHEDULE A HAS BEEN CHECKED, BECAUSE THIS LINE DESCRIBES THE REASON FOR PUBLIC CHARITY STATUS FOR TWO OF THE FOUR ORGANIZATIONS INCLUDED IN THIS GROUP RETURN. HOWEVER, PER THE IRS INSTRUCTIONS FOR GROUP RETURNS, LINES 11E-11G OF PART I OF SCHEDULE A SHOULD ALSO HAVE BEEN COMPLETED BECAUSE TWO OF THE ORGANIZATIONS INCLUDED IN THE GROUP RETURN, WINTERGREEN APARTMENTS, INC. AND CHRISTIAN COMMUNITY CAMPUS FOUNDATION, INC., ARE SUPPORTING ORGANIZATIONS. THESE ORGANIZATION'S PURPOSE IS TO PROVIDE MANAGEMENT, OVERSIGHT, FUNDRAISING, INVESTMENT, AND FUNDING SERVICES TO CHRISTIAN COMMUNITY HOMES AND SERVICES, INC., WHICH INCLUDES CHRISTIAN COMMUNITY HOME OF HUDSON, INC. AND CHRISTIAN COMMUNITY HOME OF OSCEOLA, INC. WINTERGREEN APARTMENTS, INC. AND CHRISTIAN COMMUNITY CAMPUS FOUNDATION, INC. ARE TYPE II SUPPORTING ORGANIZATIONS THAT ARE NOT CONTROLLED DIRECTLY OR INDIRECTLY BY ONE OR MORE DISQUALIFIED PERSONS OTHER THAN THE MANAGERS AND OTHER THAN ONE OR MORE PUBLICLY SUPPORTED ORGANIZATIONS DESCRIBED IN SECTION 509(A)(1) OR SECTION 509(A)(2). CHRISTIAN COMMUNITY CAMPUS FOUNDATION, INC. PROVIDED $49,862 OF SUPPORT TO CHRISTIAN COMMUNITY HOME OF HUDSON, INC. - EIN 39-1363520 and $19,371 of support to Christian Community Home of Osceola, Inc. - EIN 80-0495631. THESE ORGANIZATIONS WERE LISTED IN THE ARTICLES OF INCORPORATION OF CHRISTIAN COMMUNITY CAMPUS FOUNDATION, INC., WERE ORGANIZED IN THE U.S., AND WERE NOTIFIED OF THE SUPPORT RECEIVED. Wintergreen Apartments, Inc. OWNS THE PROPERTY AND RELATED DEBT FINANCING FOR THE FACILITY USED BY CHRISTIAN COMMUNITY HOME OF HUDSON, INC. - EIN 39-1363520. SCHEDULE A, LINE 11E: WINTERGREEN APARTMENTS, INC. RECEIVED A LETTER STATING THAT IT IS A TYPE II SUPPORTING ORGANIZATION. SCHEDULE A, LINE 11F: WINTERGREEN APARTMENTS, INC. 93-0838759 SUPPORTS ONE ORGANIZATION AND CHRISTIAN COMMUNITY CAMPUS FOUNDATION SUPPORTS THREE ORGANIZATIONS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 493 493 0 Part II-B, Line 1: CHRISTIAN COMMUNITY HOMES AND SERVICES PAYS ANNUAL ASSOCIATION DUES TO LEADING AGE WISCONSIN. THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL INDUSTRY ENVIRONMENT. Schedule C, Part II-B, Line i Christian Community Homes and Services pays annual association dues to Leading Age Wisconsin. These dues are primarily for access to educational materials and staff training and development. A portion of the annual dues were used in conjunction with lobbying activities with the goal of improving the overall industry environment. 331453 331453 27881016 14359906 13521110 3970280 2779283 1190997 15043560 TENANT DEPOSIT FUNDS 279356 F CAPITAL IMPROVEMENT FUND 360536 F BOND RESERVE FUND 603715 F BOND REPAIR AND REPLACEMENT FUND 519824 F Deferred Compensation Plan Assets 308360 F Critical Repairs Fund 21088 F Hud Escrow Accounts 134509 F 2227388 Deferred Compensation Plan Liability 308360 308360 River Cruise 18715 18715 418 300 5644 450 246 1 6907 700 6207 1062 860 291 25622 700 24922 418 300 6706 1310 537 9271 15651 X X X 0 0 0 0 0 0 0 0 0 DAN GOODIER Executive Director 235338 0 0 0 0 0 0 0 20344 0 255682 0 0 0 A HOUSING AUTHORITY OF THE VILLAGE OF OSCEOLA 391660040 2011-04-29 7400000 construction of CCH-Osceola Facility 0 0 0 A 659484 7238302 148000 7090302 2011 0 0 1 1 A 0 0 0 0 0.00400 0.00400 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 Form 990, Part V, line 3b A Form 990-T is not required for the group return of Christian Community Homes and Services, Inc. A Form 990-T was filed for Christian Community Home of Osceola, Inc at EIN 80-0495631 Form 990, Part VI, Section A, line 7a Christian Community Homes and Services, Inc.'s Articles of Incorporation state that 60% of the Board of Directors are members of and elected by the United Methodist Church. Form 990, Part VI, Section B, line 11b A COPY OF THE RETURN IS MADE AVAILABLE TO THE BOARD OF DIRECTORS PRIOR TO FILING FOR THEIR REVIEW AND COMMENTS. THE DIRECTOR OF FINANCE OF CHRISTIAN COMMUNITY HOMES AND SERVICES, INC. REVIEWS AND APPROVES THE FORM 990 PRIOR TO SUBMISSION. Form 990, Part VI, Section B, line 12c THE EXECUTIVE DIRECTOR AND DIRECTOR OF FINANCE MONITOR THE CONFLICT OF INTEREST POLICY FOR COMPLIANCE ON AN ON-GOING BASIS TO ENSURE THAT MEMBERS OF THE BOARD OF DIRECTORS HAVE IDENTIFIED AND DISCLOSED ALL POTENTIAL CONFLICTS THAT COULD INFLUENCE THEIR DECISION MAKING IN THEIR ROLES AS BOARD MEMBERS. EXAMPLES INCLUDED IN THE POLICY INCLUDE BOARD MEMBERS WHO HAVE BUSINESS DEALINGS WITH THE ORGANIZATION OR WHO HAVE RELATIVES WHO ARE RESIDENTS OF THE ORGANIZATION. Form 990, Part VI, Section B, line 15 Christian Community Homes and Services, Inc.'s executive committee approves the compensation agreement with the executive director on an annual basis, after obtaining and considering comparability data. The basis for the compensation determination is adequately documented in the minutes of the meeting for which the determination was made. Form 990, Part VI, Section C, line 19 Christian Community Homes and Services makes its governing documents, conflict of interest policy, and audited financial statements available to the public upon request during normal business hours at the offices of christian community homes and services. Form 990, Part IX, line 11g Nursing and physician: Program service expenses 127,029. Management and general expenses 0. Fundraising expenses 0. Total expenses 127,029. physical therapy: Program service expenses 577,820. Management and general expenses 0. Fundraising expenses 0. Total expenses 577,820. occupational therapy: Program service expenses 356,498. Management and general expenses 0. Fundraising expenses 0. Total expenses 356,498. speech therapy: Program service expenses 133,405. Management and general expenses 0. Fundraising expenses 0. Total expenses 133,405. housekeeping: Program service expenses 249,128. Management and general expenses 0. Fundraising expenses 0. Total expenses 249,128. other: Program service expenses 140,788. Management and general expenses 0. Fundraising expenses 0. Total expenses 140,788. administrative services: Program service expenses 0. Management and general expenses 42,145. Fundraising expenses 0. Total expenses 42,145. Form 990, Part XI, line 9: loss on advance refunding -396,742. FORM 990, PART XI, LINE 2C: COMMITTEE RESPONSIBLE FOR OVERSIGHT OF AUDIT The Christian Community Homes and Services, Inc. board of directors assumes final responsibility for oversight of the audit of its financial statements and the selection of the independent accountant that performs the audit. No changes have been made in the past year regarding this oversight function of the governing body. Christian Community Homes and Services Inc 1320 Wisconsin St Hudson WI 54016 391801003 To serve as the parent company for several senior care facilities WI 501(c)(3) Line 12c, III-FI N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0