2013-11-04T13:48:03-06:00 2013-06-30 391173131 SCHENCK SC 712 RIVERFRONT DRIVE STE 301 SHEBOYGAN WI 53081 990 2012-07-01 396069188 SHEBOYGAN SENIOR COMMUNITY INC SHEB 9204582137 930 N 6TH STREET SHEBOYGAN WI 53081 MICHAEL JONAS 9204582137 2013-11-01 1 TERRY T STRITTMATER CPA P00012661 9204580341 2012 2015-11-30 17:44:51Z MICHAEL JONAS 930 N 6TH STREET SHEBOYGAN WI 53081 8688206 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. 14 14 233 27 0 0 7811 70573 8983855 8038129 6010 2660 155361 47427 9153037 8158789 0 0 0 0 4997535 4868125 0 0 0 3416468 3046664 8414003 7914789 739034 244000 7856780 7387813 3755989 3043022 4100791 4344791 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 6843138 8083343 OPERATION OF A FULL-TIME SKILLED NURSING HOME AND RESIDENTIAL CARE CENTER. TOTAL PATIENT DAYS: 40,374. 6843138 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 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 6 0 1 233 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X X MICHAEL JONAS 9204582137 930 N 6TH STREET SHEBOYGAN WI 53081 ATTY MICHAEL ROTH 0.00 X 0 0 0 REV RIC OLSON 0.00 X 0 0 0 JAMES F PRICE 0.00 X 0 0 0 MARCY KERPE 0.00 X 0 0 0 ATTY ELDON BOHROFEN 0.00 X 0 0 0 NANCY MCADAMS 0.00 X 0 0 0 LISA O'NEILL 0.00 X 0 0 0 DENNIS OHL 0.00 X 0 0 0 JIM HOUWERS 0.00 X 0 0 0 DORIS THUENE 0.00 X 0 0 0 GARY MAPLES 0.00 X 0 0 0 STEVE HAMER 0.00 X 0 0 0 REV ROGER CLAPP 0.00 X 0 0 0 MICHAEL BASCH 40.00 X 120867 0 0 MIKE JONAS 40.00 X 35277 0 816 156144 0 816 1 0 0 0 REHABCARE GROUP INC DIVISION OF KINDRED HEALTHCARE ST LOUIS MO 63150 PHYSICAL AND OCCUPATIONAL THERAPIES 666102 BUTEYN-PETERSON CONSTRUCTION CO INC N7337 DAIRYLAND DRIVE SHEBOYGAN WI 53083 NEW PROJECT SITE WORK 499453 SYSCO EASTERN WISCONSIN ONE SYSCO DRIVE JACKSON WI 53037 PROVIDE VARIOUS SUPPLIES AND FOOD 371367 BSG MAINTENANCE PO BOX 165 NEWBURG WI 53060 HOUSEKEEPING 236774 TOTALMED STAFFING INC 10 EAST COLLEGE AVENUE SUITE 300 APPLETON WI 54911 NURSING SERVICES 163413 10 70573 70573 MEDICARE/MEDICAID PROG 900099 5545597 5545597 RESIDENTIAL CENTER 623000 2055273 2055273 INDEPENDENT LIVING 623990 353146 353146 MISCELLANEOUS 900099 40178 40178 BEAUTY SHOP 812900 34035 34035 9900 9900 8038129 2660 2660 574631 529417 45214 45214 GUEST MEALS 721000 2213 2213 2213 8158789 8083343 0 4873 156144 134753 21391 4074014 3515915 558099 51258 43983 7275 262714 225424 37290 323995 278007 45988 6484 6484 56234 56234 80027 80027 42164 42164 54194 54194 217080 217080 39837 39837 284513 239236 45277 85753 85753 PURCHASED SERVICES AND 2063150 2063150 BAD DEBT EXPENSE 50205 50205 DUES AND SUBSCRIPTIONS 33802 33802 EMPLOYMENT COSTS 31479 31479 1742 1742 7914789 6843138 1071651 0 X 296714 38205 1814874 569431 2534213 2367972 40991 40059 87432 87284 12285409 8181343 2555864 4104066 526692 180796 7856780 7387813 1835598 1901556 383052 291082 1534319 847351 3020 3033 3755989 3043022 X 4100791 4284791 60000 4100791 4344791 7856780 7387813 244000 0 X X 0 1 X 1 0 X 70357 10334 10155 7811 70573 169230 9825942 8894962 10163659 10880398 8612760 48377721 9896299 8905296 10173814 10888209 8683333 48546951 0 0 0 48546951 3865 1681 2521 6010 2660 16737 3865 1681 2521 6010 2660 16737 99376 4564 33918 32774 2213 172845 9999540 8911541 10210253 10926993 8688206 48736533 0.99610 0.99650 0.00030 0.00030 X 826921 826921 6934978 5296676 1638302 2034587 1847049 187538 2488923 1037618 1451305 4104066 CUSTOMER ESCROW DEPOSIT UNEARNED 3033 3033 8158789 0 8158789 0 8158789 7914789 0 7914789 0 7914789 FORM 990, PART VI, SECTION B, LINE 11 A 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 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 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 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 1341917 ACTUAL BALANCE OUTSTANDING