2016-08-09T12:58:20-05:00 2015-12-31 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PKWY/PO BOX 690 EAU CLAIRE WI 547020690 990 2015-01-01 912052713 CHRISTIAN COMMUNITY HOMES AND SERVICES GROUP RETURN CHRI 7153869303 1320 WISCONSIN STREET HUDSON WI 54016 Dan Goodier Executive Director 7153869303 2016-07-29 1 HOLLY POKRANDT CPA P00449155 7158323407 2016-07-29 2015 2016-12-15 16:53:06Z Dan Goodier 1320 WISCONSIN STREET HUDSON WI 54016 15444595 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 13 363 216 269051 1101 63324 40454 14850991 15370617 6034 8262 9597 17253 14929946 15436586 0 0 0 0 7891129 8079138 0 0 0 7296474 6984878 15187603 15064016 -257657 372570 22179976 21976467 20342360 19775772 1837616 2200695 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 13165847 15065140 CHRISTIAN COMMUNITY HOME OF HUDSON, INC. IS AN 81-BED NURSING HOME (CCH-HUDSON), A 37-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 2015, CCH-HUDSON'S TOTAL NURSING HOME RESIDENT DAYS WERE 22,627 INCLUDED IN THIS TOTAL WAS 8,858 DAYS FOR RESIDENTS COVERED UNDER THE MEDICAID PROGRAM. CCH-OSCEOLA'S TOTAL NURSING HOME RESIDENT DAYS WERE 13,651, AND INCLUDED IN THIS TOTAL WAS 6,494 COVERED UNDER THE 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 2015 WERE 13,542. ADDITIONALLY, HEARTHSIDE HAD 7,160 RESIDENT DAYS FOR 2015.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 RESIDENT DAYS AT WINTERGREEN APARTMENTS FOR 2015 WERE 32,690. 13165847 1 0 0 1 0 0 0 0 0 0 1 0 1 0 1 0 1 0 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 47 0 363 1 1 1 0 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 Carla Bebault MemBER 1.00 X 0 0 0 Marian Webber Member 1.00 X 0 0 0 PASTOR BRUCE STUNKARD MEMBER 1.00 X 0 0 0 Kathleen Anderson memBER 1.00 X 0 0 0 Judy Freund memBER 1.00 X 0 0 0 Jim Jones 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 Ron Langness memBER 1.00 X 0 0 0 Wayne Sprecher memBER 1.00 X 0 0 0 Sue Burmood treasurer 1.00 X X 0 0 0 Arvid Ledin pRESIDENT 1.00 X X 0 0 0 Jeff Maki vice president/secretary 1.00 X X 0 0 0 DAN GOODIER Executive Director 40.00 X 229939 0 22019 Mary Eells Director of Operations 40.00 X 100667 0 6910 330606 0 28929 2 0 1 0 Rehab care Group Inc PO Box 50534 st louis MO 63150 Therapy Services 1051824 Cole Built Construction 701 Packer Drive Hudson WI 54016 Construction 110187 2 2020 38434 40454 Nursing Home 623000 10507364 10507364 assisted living 623990 4494485 4494485 CAFETERIA & VENDING 623000 305477 269051 36426 SENIOR NUTRITION PROGRAMS 624210 63291 63291 15370617 8262 8262 5000 0 5000 5000 5000 20262 2020 8009 12253 12253 15436586 15065140 269051 61941 X 359535 359535 6546934 5837408 709526 103644 92411 11233 568174 506598 61576 500851 425104 75747 32173 32173 70542 70542 1567283 1510527 56756 84292 84292 442038 191993 250045 41862 41862 1403046 1403046 30250 30250 1237856 1237856 99034 99034 Dietary Supplies 808482 808482 Medical Supplies 565725 565725 REPAIRS/MAINT 273741 273653 88 ASSESSMENT 260639 260639 67915 52405 15510 15064016 13165847 1898169 0 1252693 2177243 92311 104033 55518 0 1115316 937983 124855 122026 31903819 16074171 16224297 15829648 2568796 2082486 746190 723048 22179976 21976467 961763 781956 6923989 6755101 12235759 11940880 0 52384 220849 245451 20342360 19775772 X 1782098 2200695 55518 0 1837616 2200695 22179976 21976467 372570 -9491 0 X X 0 1 X 1 1 1 X 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 $12,437 OF SUPPORT TO CHRISTIAN COMMUNITY HOME OF HUDSON, INC. - EIN 39-1363520 and $3,915 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. Schedule A, Part IV, Section A, Line 5b Wintergreen Apartments, Inc. is a Type II supporting organization. This is in addition to Christian Community Campus Foundation, Inc., another Type II supporting organization. 0 0 0 0 0 0 0 0 1 494 494 0 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 27600145 13463288 14136857 3972221 2610883 1361338 15829648 TENANT DEPOSIT FUNDS 219590 F CAPITAL IMPROVEMENT FUND 340425 F BOND RESERVE FUND 602739 F BOND REPAIR AND REPLACEMENT FUND 564391 F Deferred Compensation Plan Assets 245451 F Critical Repairs Fund 21067 F HUD Insurance Escrow Accounts 88823 F 2082486 Deferred Compensation Plan Liability 245451 245451 15375617 8009 8009 15367608 68978 68978 15436586 15072025 8009 8009 15064016 0 15064016 Part XI, Line 2d - Other Adjustments: FUNDRAISING EXPENSES 8,009. Part XI, Line 4b - Other Adjustments: INTEREST INCOME 8,262. CONTRIBUTIONS 60,716. Part XII, Line 2d - Other Adjustments: fundraising expenses 8,009. River Cruise 18487 18487 329 300 5427 360 206 1 3795 2020 1775 846 250 291 22282 2020 20262 329 300 6273 610 497 8009 12253 X X X 0 0 0 0 0 0 0 0 0 DAN GOODIER Executive Director 229939 0 0 0 0 0 12213 0 9806 0 251958 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 483201 7238302 148000 7090302 2011 0 0 1 1 A 0 0 0 0 0.00460 0.00460 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 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 11 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 82,795. Management and general expenses 0. Fundraising expenses 0. Total expenses 82,795. physical therapy: Program service expenses 544,269. Management and general expenses 0. Fundraising expenses 0. Total expenses 544,269. occupational therapy: Program service expenses 407,342. Management and general expenses 0. Fundraising expenses 0. Total expenses 407,342. speech therapy: Program service expenses 88,097. Management and general expenses 0. Fundraising expenses 0. Total expenses 88,097. housekeeping: Program service expenses 250,146. Management and general expenses 0. Fundraising expenses 0. Total expenses 250,146. other: Program service expenses 137,878. Management and general expenses 0. Fundraising expenses 0. Total expenses 137,878. administrative services: Program service expenses 0. Management and general expenses 56,756. Fundraising expenses 0. Total expenses 56,756. 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 11c, III-FI N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0