2015-10-28T16:45:36-05:00 2015-06-30 391173131 SCHENCK SC 712 RIVERFRONT DRIVE STE 301 SHEBOYGAN WI 53081 990 2014-07-01 396069188 SHEBOYGAN SENIOR COMMUNITY INC SHEB 9204582137 930 N 6TH STREET SHEBOYGAN WI 53081 TARA HOLZEM OFFICER 9204582137 2015-09-16 1 TERRY T STRITTMATER CPA P00012661 9204580341 2014 2016-02-25 16:41:14Z TARA HOLZEM 930 N 6TH STREET SHEBOYGAN WI 53081 6083187 0 X WWW.RETIRESHEBOYGAN.COM X 1962 WI TO PROVIDE AND OPERATE A RETIREMENT HOME, HEALTH CARE CENTER, AND RELATED SERVICES IN THE GREATER SHEBOYGAN AREA FOR ELDERLY AND PHYSICALLY HANDICAPPED ADULTS, WHICH SHALL ENHANCE, HONOR AND PRESERVE THE DIGNITY OF THE INDIVIDUAL, AND WHERE SPIRITUAL, PHYSICAL AND SOCIAL NEEDS ARE SUPPLIED IN A SPIRIT OF CHRISTIAN LOVE AND CONCERN WITHOUT REGARD TO AGE, SEX, RACE, CREED OR COLOR. 13 13 198 28 0 0 19676 477831 6956077 5556950 -5778 4034 27820 44372 6997795 6083187 0 0 0 0 4653177 4084983 0 0 0 2779845 2342160 7433022 6427143 -435227 -343956 6747022 19937320 2837458 16371712 3909564 3565608 X TO PROVIDE AND OPERATE A RETIREMENT HOME, HEALTH CARE CENTER, AND RELATED SERVICES IN THE GREATER SHEBOYGAN AREA FOR ELDERLY AND PHYSICALLY HANDICAPPED ADULTS, WHICH SHALL ENHANCE, HONOR AND PRESERVE THE DIGNITY OF THE INDIVIDUAL, AND WHERE SPIRITUAL, PHYSICAL AND SOCIAL NEEDS ARE SUPPLIED IN A SPIRIT OF CHRISTIAN LOVE AND CONCERN WITHOUT REGARD TO AGE, SEX, RACE, CREED OR COLOR. 0 0 5660909 5556950 OPERATION OF A FULL-TIME SKILLED NURSING HOME AND RESIDENTIAL CARE CENTER. TOTAL PATIENT DAYS: 26,843. 5660909 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 6 0 1 198 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X TARA HOLZEM 9204582137 930 N 6TH STREET SHEBOYGAN WI 53081 JIM HOUWERS PRESIDENT 0.00 X X 0 0 0 DORIS THUENE SECRETARY 0.00 X X 0 0 0 GARY MAPLES TREASURER 0.00 X X 0 0 0 STEVE HAMER VICE PRESIDENT 0.00 X X 0 0 0 REV ROGER CLAPP DIRECTOR 0.00 X 0 0 0 REV RIC OLSON DIRECTOR 0.00 X 0 0 0 JAMES F PRICE DIRECTOR 0.00 X 0 0 0 MARCY KERPE DIRECTOR 0.00 X 0 0 0 LYNN COADY DIRECTOR 0.00 X 0 0 0 NANCY MCADAMS DIRECTOR 0.00 X 0 0 0 PERRY FRITZ DIRECTOR 0.00 X 0 0 0 DENNIS OHL DIRECTOR 0.00 X 0 0 0 DAVID VANDEWATER DIRECTOR 0.00 X 0 0 0 STEPHANIE MALIS DIRECTOR 0.00 X 0 0 0 JOAN KLEIST EXECUTIVE DIRECTOR 40.00 X 107459 0 13133 TARA HOLZEM BUSINESS MANAGER 40.00 X 47564 0 979 155023 0 14112 1 0 0 0 JOS SCHMITT CONSTRUCTION INC 2104 UNION AVE SHEBOYGAN WI 53081 NEW BUILDING CONSTRUCTION 3086705 BUTEYN-PETERSON CONSTRUCTION CO INC N7337 DAIRYLAND DR SHEBOYGAN WI 53081 NEW BUILDING CONSTRUCTION 708422 REHABCARE GROUP INC PO BOX 277365 ATLANTA GA 30384 THERAPY SERVICES 551738 ELITE NURSES INC PO BOX 1785 FOND DU LAC WI 54936 NURSING STAFFING SERVICE 352419 SYSCO EASTERN WISCONSIN ONE SYSCO DR JACKSON WI 53037 RAW FOOD AND SUPPLIES 288970 12 477831 477831 MEDICARE/MEDICAID PROG 900099 3703670 3703670 RESIDENTIAL CENTER 623000 1352080 1352080 INDEPENDENT LIVING 623990 435597 435597 OTHER SERVICES 900099 39025 39025 BEAUTY SHOP 812900 26578 26578 5556950 4034 4034 CHANGE IN PRESENT VALU 900099 44372 44372 44372 6083187 5556950 0 48406 186989 165175 21814 3347898 2957332 390566 48506 42497 6009 254316 222814 31502 247274 216644 30630 12307 12307 13650 13650 66311 66311 55583 55583 36320 36320 190868 190868 30252 30252 262077 223520 38557 95551 95551 PURCHASED SERVICES AND 1516256 1516256 DUES AND SUBSCRIPTIONS 46369 46369 EMPLOYMENT COSTS 9550 9550 BAD DEBT EXPENSE 3789 3789 3277 3277 6427143 5660909 766234 0 X 711125 246695 392275 3853268 1611795 1321407 38990 43498 82235 62223 23103319 8702423 3899269 14400896 11333 9333 6747022 19937320 2098680 1760424 738778 14611288 2837458 16371712 X 3839564 3319665 70000 245943 3909564 3565608 6747022 19937320 -343956 0 X X 0 1 X 1 0 X 10155 7811 70573 19676 477831 586046 10163659 10880398 8612760 7156437 5556950 42370204 10173814 10888209 8683333 7176113 6034781 42956250 0 0 0 42956250 2521 6010 2660 1305 4034 16530 2521 6010 2660 1305 4034 16530 33918 32774 2213 2668 44372 115945 10210253 10926993 8688206 7180086 6083187 43088725 0.99690 0.99800 0.00040 0.00030 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2010 AMOUNT: $ 33,918. 2011 AMOUNT: $ 32,774. 2012 AMOUNT: $ 2,213. 2013 AMOUNT: $ 2,668. 2014 AMOUNT: $ 0. CHANGE IN PRESENT VALUE OF DEVELOPMENT INCENTIVE RECEIVABLE - 2010 AMOUNT: $ 0. 2011 AMOUNT: $ 0. 2012 AMOUNT: $ 0. 2013 AMOUNT: $ 0. 2014 AMOUNT: $ 44,372. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 826921 826921 6934978 5649344 1285634 2043441 1943717 99724 13297979 1109362 12188617 14400896 X PART X, LINE 2: THE ORGANIZATION FOLLOWS THE GUIDANCE FOR ACCOUNTING FOR UNCERTAINTIES IN INCOME TAXES WHICH IS PART OF FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES. THIS GUIDANCE INCREASES THE RELEVANCY AND COMPARABILITY OF FINANCIAL REPORTING BY CLARIFYING THE WAY ORGANIZATIONS ACCOUNT FOR UNCERTAINTIES IN INCOME TAXES FOR TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN. IT MAKES RECOGNITION AND MEASUREMENT MORE CONSISTENT AS WELL AS OFFERING CLEAR CRITERIA FOR SUBSEQUENTLY RECOGNIZING, DERECOGNIZING AND MEASURING SUCH TAX POSITIONS FOR FINANCIAL STATEMENT PURPOSES. PENALTIES AND INTEREST ASSESSED BY INCOME TAXING AUTHORITIES ARE INCLUDED IN MANAGEMENT AND GENERAL EXPENSES, IF APPLICABLE. THE ORGANIZATION HAD NO INTEREST AND PENALTIES RELATED TO INCOME TAXES FOR THE YEARS ENDED JUNE 30, 2015 AND 2014. THE ORGANIZATION'S FEDERAL RETURNS ARE SUBJECT TO EXAMINATION GENERALLY FOR THREE YEARS AFTER THEY ARE FILED AND ITS STATE RETURNS GENERALLY FOR FOUR YEARS AFTER THEY ARE FILED. FORM 990, PART VI, SECTION B, LINE 11 A PDF COPY OF FORM 990 IS EMAILED TO THE BUSINESS MANAGER. THE BUSINESS MANAGER FORWARDS THE EMAIL TO THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN. THE 990 IS REVIEWED BY THE BUSINESS MANAGER PRIOR TO FILING. THE BUSINESS MANAGER CHECKS FORM 990 WITH INTERNAL REPORTS. FORM 990, PART VI, SECTION B, LINE 12C A NEW CONFLICT OF INTEREST POLICY IS FILLED OUT ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15A SHEBOYGAN SENIOR COMMUNITY, INC. USES DATA GATHERED FOR THEIR STATE ASSOCIATION (WISCONSIN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING) BY MANAGEMENT RESOURCE ASSOCIATES (MRA), A THIRD PARTY INDEPENDENT, NOT FOR PROFIT, MANAGEMENT CONSULTING GROUP. THE DATA IS GATHERED FROM PARTICIPATING NOT FOR PROFIT HOMES THROUGHOUT THE STATE OF WISCONSIN. SALARY RECOMMENDATIONS FOR THE EXECUTIVE DIRECTOR ARE REVIEWED AND SET BY THE EXECUTIVE COMMITTEE IN AN EXECUTIVE SESSION WITHOUT THE EXECUTIVE DIRECTOR'S PRESENCE AFTER THE FULL ANNUAL PERFORMANCE EVALUATION, UTILIZING THE DATA DESCRIBED ABOVE. NO OTHER MANAGEMENT STAFF ARE REVIEWED IN THIS MANNER, THOUGH ALL SALARY AND EXPENSE DATA IS REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD IN THEIR ANNUAL BUDGET PREPARATION AND APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. FROM 990, PART XI, LINE 2C: THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. SHEBOYGAN SENIOR COMMUNITY FOUNDATION 930 N 6TH STREET SHEBOYGAN WI 53081 391450846 RAISE/RECEIVE FUNDS TO BE USED FOR GENERAL SUPPORT OF THIS ORGANIZATION WI 501(C)(3) 11 BOARD OF DIRECTORS 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SHEBOYGAN SENIOR COMMUNITY FOUNDATION E 1361565 ACTUAL BALANCE OUTSTANDING SHEBOYGAN SENIOR COMMUNITY FOUNDATION C 300000 GRANT AMOUNT RECEIVED