SHEBOYGAN SENIOR COMMUNITY INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
SHEBOYGAN SENIOR COMMUNITY INC (EIN 39-6069188)
Tax period
2012-07-01 to 2013-06-30
Filed
2013-11-04
IRS object ID
201313089349301121
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-04T13:48:03-06:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN391173131EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1SCHENCK SCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1712 RIVERFRONT DRIVE STE 301AddressLine1
CitySHEBOYGANCity
StateWIState
ZIP Code53081ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN396069188EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SHEBOYGAN SENIOR COMMUNITY INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSHEBNameControl
Phone9204582137Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1930 N 6TH STREETAddressLine1
CitySHEBOYGANCity
StateWIState
ZIP Code53081ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHAEL JONASName
TitleOFFICERTitle
Phone9204582137Phone
Date Signed2013-11-01DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTERRY T STRITTMATER CPAName
PTINP00012661PTIN
Phone9204580341Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMICHAEL JONASNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1930 N 6TH STREETAddressLine1
CitySHEBOYGANCity
StateWIState
ZIP Code53081ZIPCode
FieldValueIRS element (for citing)
Gross Receipts8688206GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.RETIRESHEBOYGAN.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1962YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionTO 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees233TotalNbrEmployees
Total Nbr Volunteers27TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year7811ContributionsGrantsPriorYear
Contributions Grants Current Year70573ContributionsGrantsCurrentYear
Program Service Revenue Prior Year8983855ProgramServiceRevenuePriorYear
Program Service Revenue CY8038129ProgramServiceRevenueCY
Investment Income Prior Year6010InvestmentIncomePriorYear
Investment Income Current Year2660InvestmentIncomeCurrentYear
Other Revenue Prior Year155361OtherRevenuePriorYear
Other Revenue Current Year47427OtherRevenueCurrentYear
Total Revenue Prior Year9153037TotalRevenuePriorYear
Total Revenue Current Year8158789TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4997535SalariesEtcPriorYear
Salaries Etc Current Year4868125SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3416468OtherExpensePriorYear
Other Expenses Current Year3046664OtherExpensesCurrentYear
Total Expenses Prior Year8414003TotalExpensesPriorYear
Total Expenses Current Year7914789TotalExpensesCurrentYear
Revenues Less Expenses Prior Year739034RevenuesLessExpensesPriorYear
Revenues Less Expenses CY244000RevenuesLessExpensesCY
Total Assets BOY7856780TotalAssetsBOY
Total Assets EOY7387813TotalAssetsEOY
Total Liabilities BOY3755989TotalLiabilitiesBOY
Total Liabilities EOY3043022TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4100791NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4344791NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense6843138Expense
Revenue8083343Revenue
DescriptionOPERATION OF A FULL-TIME SKILLED NURSING HOME AND RESIDENTIAL CARE CENTER. TOTAL PATIENT DAYS: 40,374.Description
Total Program Service Expense6843138TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10966NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees233NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Excess Business Holdings0ExcessBusinessHoldings
Taxable Distributions0TaxableDistributions
Distribution To Donor0DistributionToDonor
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1MICHAEL JONASBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9204582137TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1930 N 6TH STREETAddressLine1
CitySHEBOYGANCity
StateWIState
ZIP Code53081ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
ATTY MICHAEL ROTH
DIRECTOR0.00X000
REV RIC OLSON
DIRECTOR0.00X000
JAMES F PRICE
DIRECTOR0.00X000
MARCY KERPE
DIRECTOR0.00X000
ATTY ELDON BOHROFEN
DIRECTOR0.00X000
NANCY MCADAMS
DIRECTOR0.00X000
LISA O'NEILL
DIRECTOR0.00X000
DENNIS OHL
DIRECTOR0.00X000
JIM HOUWERS
PRESIDENT0.00000X
DORIS THUENE
SECRETARY0.00000X
GARY MAPLES
TREASURER0.00000X
STEVE HAMER
VICE PRESIDENT0.00000X
REV ROGER CLAPP
VICE PRESIDENT0.00000X
MICHAEL BASCH
EXECUTIVE DIRECTOR40.0012086700X
MIKE JONAS
BUSINESS MANAGER40.00352770816X
FieldValueIRS element (for citing)
Total Reportable Comp From Org156144TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation816TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
REHABCARE GROUP INC
DIVISION OF KINDRED HEALTHCAREST LOUISMO63150PHYSICAL AND OCCUPATIONAL THERAPIES666102
BUTEYN-PETERSON CONSTRUCTION CO INC
N7337 DAIRYLAND DRIVESHEBOYGANWI53083NEW PROJECT SITE WORK499453
SYSCO EASTERN WISCONSIN
ONE SYSCO DRIVEJACKSONWI53037PROVIDE VARIOUS SUPPLIES AND FOOD371367
BSG MAINTENANCE
PO BOX 165NEWBURGWI53060HOUSEKEEPING236774
TOTALMED STAFFING INC
10 EAST COLLEGE AVENUE SUITE 300APPLETONWI54911NURSING SERVICES163413
FieldValueIRS element (for citing)
Number Of Contractors GT100 K10NumberOfContractorsGT100K
All Other Contributions70573AllOtherContributions
Total Contributions70573TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICARE/MEDICAID PROG90009955455975545597
RESIDENTIAL CENTER62300020552732055273
INDEPENDENT LIVING623990353146353146
MISCELLANEOUS9000994017840178
BEAUTY SHOP8129003403534035

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column9900TotalRevenueColumn
Related Or Exempt Function Income9900RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue8038129TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2660TotalRevenueColumn
Exclusion$2,660ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory574631GrossSalesOfInventory
Cost Of Goods Sold529417CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column45214TotalRevenueColumn
Related Or Exempt Function Income45214RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionGUEST MEALSDescription
Business Code721000BusinessCode
Total Revenue Column2213TotalRevenueColumn
Exclusion$2,213ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue2213TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column8158789TotalRevenueColumn
Related Or Exempt Function Income8083343RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$4,873ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total156144Total
Program Services134753ProgramServices
Management And General21391ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4074014Total
Program Services3515915ProgramServices
Management And General558099ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total51258Total
Program Services43983ProgramServices
Management And General7275ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total262714Total
Program Services225424ProgramServices
Management And General37290ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total323995Total
Program Services278007ProgramServices
Management And General45988ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total6484Total
Management And General6484ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total56234Total
Management And General56234ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total80027Total
Management And General80027ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total42164Total
Management And General42164ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total54194Total
Management And General54194ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total217080Total
Program Services217080ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total39837Total
Program Services39837ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total284513Total
Program Services239236ProgramServices
Management And General45277ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total85753Total
Program Services85753ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCHASED SERVICES AND20631502063150
BAD DEBT EXPENSE5020550205
DUES AND SUBSCRIPTIONS3380233802
EMPLOYMENT COSTS3147931479

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1742Total
Management And General1742ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total7914789Total
Program Services6843138ProgramServices
Management And General1071651ManagementAndGeneral
Fundraising0Fundraising
FieldValueIRS element (for citing)
Joint CostsXJointCosts

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY296714BOY
EOY38205EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1814874BOY
EOY569431EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2534213BOY
EOY2367972EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY40991BOY
EOY40059EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY87432BOY
EOY87284EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis12285409LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec8181343LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2555864BOY
EOY4104066EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY526692BOY
EOY180796EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7856780BOY
EOY7387813EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1835598BOY
EOY1901556EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY383052BOY
EOY291082EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1534319BOY
EOY847351EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY3020BOY
EOY3033EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3755989BOY
EOY3043022EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4100791BOY
EOY4284791EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
EOY60000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4100791BOY
EOY4344791EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7856780BOY
EOY7387813EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses244000ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years70357CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10334CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10155CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7811CurrentTaxYearMinus1Year
Current Tax Year70573CurrentTaxYear
Total169230Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9825942CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8894962CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10163659CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10880398CurrentTaxYearMinus1Year
Current Tax Year8612760CurrentTaxYear
Total48377721Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9896299CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8905296CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10173814CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10888209CurrentTaxYearMinus1Year
Current Tax Year8683333CurrentTaxYear
Total48546951Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50948546951PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3865CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1681CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2521CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6010CurrentTaxYearMinus1Year
Current Tax Year2660CurrentTaxYear
Total16737Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3865CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1681CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2521CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6010CurrentTaxYearMinus1Year
Current Tax Year2660CurrentTaxYear
Total16737Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years99376CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4564CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years33918CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year32774CurrentTaxYearMinus1Year
Current Tax Year2213CurrentTaxYear
Total172845Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9999540CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8911541CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10210253CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10926993CurrentTaxYearMinus1Year
Current Tax Year8688206CurrentTaxYear
Total48736533Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99610PublicSupportPercentage509
Prior Year Support Percentage0.99650PriorYearSupportPercentage
Investment Income Percentage0.00030InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00030PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis826921OtherCostOrOtherBasis
Book Value826921BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6934978OtherCostOrOtherBasis
Depreciation5296676Depreciation
Book Value1638302BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2034587OtherCostOrOtherBasis
Depreciation1847049Depreciation
Book Value187538BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2488923OtherCostOrOtherBasis
Depreciation1037618Depreciation
Book Value1451305BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings4104066TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionCUSTOMER ESCROW DEPOSIT UNEARNEDDescription
Amount$3,033Amount
FieldValueIRS element (for citing)
Total Of Amounts3033TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt8158789TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal8158789RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9908158789TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt7914789TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal7914789ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9907914789TotalExpensesPerForm990

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11A PDF COPY OF FORM 990 IS EMAILED TO THE CHIEF FINANCIAL OFFICER. THE CFO FORWARDS THE EMAIL TO THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN. THE 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER PRIOR TO FILING. THE CFO CHECKS FORM 990 WITH INTERNAL REPORTS.
FORM 990, PART VI, SECTION B, LINE 12CA NEW CONFLICT OF INTEREST POLICY IS FILLED OUT ON AN ANNUAL BASIS.
FORM 990, PART VI, SECTION B, LINE 15ASHEBOYGAN 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 CEO ARE REVIEWED AND SET BY THE EXECUTIVE COMMITTEE IN AN EXECUTIVE SESSION WITHOUT THE CEO'S PRESENCE AFTER THE FULL ANNUAL PERFORMANCE EVALUATION, UTILIZING THE DATA DESCRIBED ABOVE. NO OTHER MANAGEMENT STAFF ARE REVIEWED IN THIS MANOR, 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 19THESE 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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1SHEBOYGAN SENIOR COMMUNITY FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1930 N 6TH STREETAddressLine1
CitySHEBOYGANCity
StateWIState
ZIP Code53081ZIPCode
FieldValueIRS element (for citing)
EIN391450846EIN
Primary ActivitiesRAISE/RECEIVE FUNDS TO BE USED FOR GENERAL SUPPORT OF THIS ORGANIZATIONPrimaryActivities
Legal Domicile StateWILegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status11PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1BOARD OF DIRECTORSBusinessNameLine1
FieldValueIRS element (for citing)
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1SHEBOYGAN SENIOR COMMUNITY FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeETransactionType
Amount Involved1341917AmountInvolved
Method Of Amt DeterminationACTUAL BALANCE OUTSTANDINGMethodOfAmtDetermination

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