2012-11-12T14:46:25-06:00 2012-06-30 391173131 SCHENCK SC 712 RIVERFRONT DRIVE STE 301 SHEBOYGAN WI 53081 990 2011-07-01 396069188 SHEBOYGAN SENIOR COMMUNITY INC SHEB 9204582137 930 N 6TH STREET SHEBOYGAN WI 53081 MICHAEL JONAS 9204582137 2012-10-04 1 TERRY T STRITTMATER CPA P00012661 9204580341 2011 2016-02-24 21:20:13Z MICHAEL JONAS 930 N 6TH STREET SHEBOYGAN WI 53081 10926993 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. 15 15 258 27 0 0 10155 7811 9058728 8983855 2330 6010 -266724 155361 8804489 9153037 0 0 0 0 4969922 4997535 0 0 0 4867260 3416468 9837182 8414003 -1032693 739034 9257769 7856780 5896012 3755989 3361757 4100791 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 7404375 8983855 OPERATION OF A FULL-TIME SKILLED NURSING HOME AND RESIDENTIAL CARE CENTER. TOTAL PATIENT DAYS: 43,204. 7404375 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 1 8 0 1 258 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 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 JOHN HUMBERT 0.00 X 0 0 0 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 STEVE HAMER 0.00 X 0 0 0 REV ROGER CLAPP 0.00 X 0 0 0 GARY MAPLES 0.00 X 0 0 0 MICHAEL BASCH 40.00 X 120178 0 2600 BARB TESS 40.00 X 59059 0 1989 179237 0 4589 1 0 0 0 PEOPLE FIRST REHABILITATION BOX 277365 ATLANTA GA 303847365 PHYSICAL AND OCCUPATIONAL THERAPIES 507541 SYSCO EASTERN WISCONSIN ONE SYSCO DRIVE JACKSON WI 53037 PROVIDE VARIOUS SUPPLIES AND FOOD 374441 REHABCARE GROUP INC DIVISION OF KINDRED HEALTHCARE ST LOUIS MO 63150 PHYSICAL AND OCCUPATIONAL THERAPIES 286613 BSG MAINTENANCE PO BOX 165 NEWBURG WI 53060 HOUSEKEEPING 236652 BURKHART HEISDORF INSURANCE 1807 ERIE AVENUE SHEBOYGAN WI 53082 COMPANY INSURANCE 115498 7 7811 7811 MEDICARE/MEDICAID PROG 900099 6474308 6474308 RESIDENTIAL CENTER 623000 2087295 2087295 INDEPENDENT LIVING 623990 311106 311106 MISCELLANEOUS 900099 63725 63725 BEAUTY SHOP 812900 36861 36861 10560 10560 8983855 6010 6010 1896543 1773956 122587 122587 FORFEITURE REVENUE 900099 29679 29679 GUEST MEALS 721000 3095 3095 32774 9153037 9106442 0 38784 179237 154257 24980 4105037 3615233 489804 49587 43439 6148 313363 274512 38851 350311 306879 43432 2986 2986 63432 63432 44479 2229 42250 51644 51644 312558 311317 1241 2298 2298 44715 44715 305300 255175 50125 85556 85556 PURCHASED SERVICES AND 2316453 2262076 54377 BAD DEBT EXPENSE 70364 70364 INVENTORY HOLDING COSTS 42782 42782 DUES AND SUBSCRIPTIONS 34469 34469 39432 6205 33227 8414003 7404375 1009628 0 X 293922 296714 801660 1814874 3051860 2534213 40457 40991 89276 87432 10454694 7898830 2738732 2555864 2241862 526692 9257769 7856780 1861044 1835598 387845 383052 3647123 1534319 0 3020 5896012 3755989 X 3361757 4100791 3361757 4100791 9257769 7856780 739034 0 X X 0 1 1 X 0 X 31043 70357 10334 10155 7811 129700 14428203 9825942 8894962 10163659 10880398 54193164 14459246 9896299 8905296 10173814 10888209 54322864 0 0 0 54322864 959 3865 1681 2521 6010 15036 959 3865 1681 2521 6010 15036 4585 99376 4564 33918 32774 175217 14464790 9999540 8911541 10210253 10926993 54513117 0.99650 0.99650 0.00030 0.00070 X 254703 254703 6934978 5116456 1818522 1984977 1784636 200341 1280036 997738 282298 2555864 BOND FEES NET OF ACCUMULATED DEPREC 15333 LANDMARK SQUARE PROJECT 508339 CUSTOMER ESCROW DEPOSIT 3020 526692 CUSTOMER ESCROW DEPOSIT UNEARNED 3020 3020 9153037 8414003 739034 739034 9081318 80547 80547 9000771 152266 152266 9153037 8342284 80547 80547 8261737 152266 152266 8414003 PART XII, LINE 2D - OTHER ADJUSTMENTS: GAIN FROM SALES OF INVENTORY REPORTED ON THE FINANCIAL STATEMENTS 80,547. PART XII, LINE 4B - OTHER ADJUSTMENTS: FORFEITURES 29,679. GAIN FROM SALES OF INVENTORY INCLUDED ON 990 PAGE 9, LINE 10C 122,587. PART XIII, LINE 2D - OTHER ADJUSTMENTS: GAIN FROM SALES OF INVENTORY REPORTED ON THE FINANCIAL STATEMENTS 80,547. PART XIII, LINE 4B - OTHER ADJUSTMENTS: FORFEITURES 29,679. GAIN FROM SALES OF INVENTORY INCLUDED ON 990 PAGE 9, LINE 10C 122,587. MICHAEL ROTH PARTNER AT WURTZ, ROTH, BASLER, AND BROCK 2047 SHEBOYGAN SENIOR COMMUNITY, INC. USED WURTZ, ROTH, BASLER, AND BROCK FOR LAW SERVICES 0 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 1 0 0 0 SHEBOYGAN SENIOR COMMUNITY FOUNDATION E 1256847 ACTUAL BALANCE OUTSTANDING