2014-11-07T11:29:30-06:00 2014-06-30 391173131 SCHENCK SC 712 RIVERFRONT DRIVE STE 301 SHEBOYGAN WI 53081 990 2013-07-01 396069188 SHEBOYGAN SENIOR COMMUNITY INC SHEB 9204582137 930 N 6TH STREET SHEBOYGAN WI 53081 TARA HOLZEM OFFICER 9204582137 2014-10-28 1 TERRY T STRITTMATER CPA P00012661 9204580341 2013 2015-11-30 17:44:51Z TARA HOLZEM 930 N 6TH STREET SHEBOYGAN WI 53081 7180086 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 13 239 27 0 0 70573 19676 8038129 6956077 2660 -5778 47427 27820 8158789 6997795 0 0 0 0 4868125 4653177 0 0 0 3046664 2779845 7914789 7433022 244000 -435227 7387813 6747022 3043022 2837458 4344791 3909564 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 6465681 6981229 OPERATION OF A FULL-TIME SKILLED NURSING HOME AND RESIDENTIAL CARE CENTER. TOTAL PATIENT DAYS: 34,244. 6465681 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 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 7 0 1 239 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 REV ROGER CLAPP DIRECTOR 0.00 X 0 0 0 ATTY MICHAEL ROTH 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 ATTY ELDON BOHROFEN DIRECTOR 0.00 X 0 0 0 NANCY MCADAMS DIRECTOR 0.00 X 0 0 0 LISA O'NEILL 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 JIM HOUWERS PRESIDENT 0.00 X 0 0 0 DORIS THUENE SECRETARY 0.00 X 0 0 0 GARY MAPLES TREASURER 0.00 X 0 0 0 STEVE HAMER VICE PRESIDENT 0.00 X 0 0 0 MICHAEL BASCH EXECUTIVE DIRECTOR 40.00 X 121672 0 21970 JOAN KLEIST EXECUTIVE DIRECTOR 40.00 X 92139 0 8840 MIKE JONAS BUSINESS MANAGER 40.00 X 75185 0 5530 TARA HOLZEM BUSINESS MANAGER 40.00 X 31779 0 669 320775 0 37009 1 0 0 0 REHABCARE GROUP INC PO BOX 503534 ST LOUIS MO 63150 THERAPIES 530596 COMMUNITY LIVING SOLUTIONS 2801 EAST ENTERPISE AVENUE SUITE 2 APPLETON WI 54913 NEW PROJECT ARCHITECTURAL SERVICES 529511 SYSCO EASTERN WISCONSIN ONE SYSCO DRIVE JACKSON WI 53037 PROVIDE VARIOUS SUPPLIES AND FOOD 353579 ELITE NURSES INC C/O ADVANTAGE ACCOUNTING 498 W SCO FOND DU LAC WI 54937 NURSING SERVICES - POOL 294604 BSG MAINTENANCE PO BOX 165 NEWBURG WI 53060 HOUSEKEEPING 235613 10 19676 19676 MEDICARE/MEDICAID PROG 900099 4822891 4822891 RESIDENTIAL CENTER 623000 1670745 1670745 INDEPENDENT LIVING 623990 409212 409212 BEAUTY SHOP 812900 29572 29572 MISCELLANEOUS 900099 14217 14217 9440 9440 6956077 1305 1305 7083 -7083 -7083 -7083 200360 175208 25152 25152 GUEST MEALS 721000 2668 2668 2668 6997795 6981229 0 -3110 320775 278963 41812 3766630 3275668 490962 58594 50568 8026 211182 182255 28927 295996 255451 40545 4887 4887 24330 24330 63975 63975 37999 37999 40761 40761 229644 229644 35213 35213 274807 230127 44680 88224 88224 PURCHASED SERVICES AND 1839568 1839568 EMPLOYMENT COSTS 68581 68581 DUES AND SUBSCRIPTIONS 34363 34363 BAD DEBT EXPENSE 32412 32412 5081 5081 7433022 6465681 967341 0 X 293914 711125 313722 392275 2367972 1611795 40059 38990 87284 82235 12341614 8442345 4104066 3899269 180796 11333 7387813 6747022 1901556 2098680 291082 0 847351 738778 3033 0 3043022 2837458 X 4284791 3839564 60000 70000 4344791 3909564 7387813 6747022 -435227 0 X X 0 1 X 1 0 X 10334 10155 7811 70573 19676 118549 8894962 10163659 10880398 8612760 7156437 45708216 8905296 10173814 10888209 8683333 7176113 45826765 0 0 0 45826765 1681 2521 6010 2660 1305 14177 1681 2521 6010 2660 1305 14177 4564 33918 32774 2213 2668 76137 8911541 10210253 10926993 8688206 7180086 45917079 0.99800 0.99610 0.00030 0.00030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 826921 826921 6934978 5474129 1460849 2027785 1894142 133643 2551930 1074074 1477856 3899269 7004430 6635 6635 6997795 0 6997795 7439657 6635 6635 7433022 0 7433022 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SHEBOYGAN SENIOR COMMUNITY FOUNDATION E 1652017 ACTUAL BALANCE OUTSTANDING