SHEBOYGAN SENIOR COMMUNITY INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
SHEBOYGAN SENIOR COMMUNITY INC (EIN 39-6069188)
Tax period
2010-07-01 to 2011-06-30
Filed
2011-10-17
IRS object ID
201122929349300702
Schema version
2010v3.4
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)
Timestamp2011-10-17T09:29:52-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2010-07-01TaxPeriodBeginDate

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)
NameBARB TESSName
TitleOFFICERTitle
Phone9204582137Phone
Date Signed2011-10-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTERRY T STRITTMATER CPAName
Phone9204580341Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonBARB TESSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1930 N 6TH STREETAddressLine1
CitySHEBOYGANCity
StateWIState
ZIP Code53081ZIPCode
FieldValueIRS element (for citing)
Gross Receipts10210253GrossReceipts
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 Body16NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees259TotalNbrEmployees
Total Nbr Volunteers14TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year10334ContributionsGrantsPriorYear
Contributions Grants Current Year10155ContributionsGrantsCurrentYear
Program Service Revenue Prior Year8440573ProgramServiceRevenuePriorYear
Program Service Revenue CY9058728ProgramServiceRevenueCY
Investment Income Prior Year4460InvestmentIncomePriorYear
Investment Income Current Year2330InvestmentIncomeCurrentYear
Other Revenue Prior Year-359554OtherRevenuePriorYear
Other Revenue Current Year-266724OtherRevenueCurrentYear
Total Revenue Prior Year8095813TotalRevenuePriorYear
Total Revenue Current Year8804489TotalRevenueCurrentYear
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 Year5085170SalariesEtcPriorYear
Salaries Etc Current Year4969922SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3176466OtherExpensePriorYear
Other Expenses Current Year4867260OtherExpensesCurrentYear
Total Expenses Prior Year8261636TotalExpensesPriorYear
Total Expenses Current Year9837182TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-165823RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1032693RevenuesLessExpensesCY
Total Assets BOY11667662TotalAssetsBOY
Total Assets EOY9257769TotalAssetsEOY
Total Liabilities BOY7273212TotalLiabilitiesBOY
Total Liabilities EOY5896012TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4394450NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3361757NetAssetsOrFundBalancesEOY
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
Expense8891606Expense
Revenue9058728Revenue
DescriptionOPERATION OF A FULL-TIME SKILLED NURSING HOME AND RESIDENTIAL CARE CENTER. TOTAL PATIENT DAYS: 46,139.Description
Total Program Service Expense8891606TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
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 Assets1ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
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 Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109610NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees259NumberOfEmployees
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
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Excess Business Holdings0ExcessBusinessHoldings
Taxable Distributions0TaxableDistributions
Distribution To Donor0DistributionToDonor
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members16NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
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 Line1BARB TESSBusinessNameLine1
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 (18 entries)

TitleTitleIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerAverage Hours Per WeekAverageHoursPerWeek
JOHN HUMBERT
DIRECTORX000
STEVE STAUBER
DIRECTORX000
REV KARL NELSON
DIRECTORX000
TRYG JACOBSON
DIRECTORX000
MARCY KERPE
DIRECTORX000
ATTY ELDON BOHROFEN
DIRECTORX000
NANCY MCADAMS
DIRECTORX000
LISA O'NEILL
DIRECTORX000
BARBARA DODGE
DIRECTORX000
REV STEVE HANUSA
DIRECTORX000
DENNIS OHL
DIRECTORX000
JIM HOUWERS
PRESIDENT000X
DORIS THEUNE
SECRETARY/TREASURER000X
STEVE HAMER
VICE PRESIDENT000X
REV ROGER CLAPP
VICE PRESIDENT000X
GARY MAPLES
VICE PRESIDENT000X
MICHAEL BASCH
EXECUTIVE DIRECTOR11977008676X40.00
BARBARA TESS
CFO6152904757X40.00
FieldValueIRS element (for citing)
Total Reportable Comp From Org181299TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation13433TotalOtherCompensation
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
PEOPLE FIRST REHABILITATION
BOX 277365ATLANTAGA303847365PHYSICAL AND OCCUPATIONAL THERAPIES836803
SYSCO EASTERN WISCONSIN
ONE SYSCO DRIVEJACKSONWI53037PROVIDE VARIOUS SUPPLIES AND FOOD372128
HUMANA
PO BOX 567CAROL STREAMIL60132HEALTH AND DENTAL INSURANCE311565
BSG MAINTENANCE
PO BOX 165NEWBURGWI53060HOUSEKEEPING236312
BURKHART HEISDORF INSURANCE
1807 ERIE AVENUESHEBOYGANWI53082COMPANY INSURANCE126296
FieldValueIRS element (for citing)
Number Of Contractors GT100 K9NumberOfContractorsGT100K
All Other Contributions10155AllOtherContributions
Total Contributions10155TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICARE/MEDICAID PROG90009963046876304687
RESIDENTIAL CENTER62300024081042408104
INDEPENDENT LIVING623990270371270371
BEAUTY SHOP8129003670536705
MISCELLANEOUS9000992749127491

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column11370TotalRevenueColumn
Related Or Exempt Function Income11370RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue9058728TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2521TotalRevenueColumn
Exclusion$2,521ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other191Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-191Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-191TotalRevenueColumn
Exclusion-$191ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory1104931GrossSalesOfInventory
Cost Of Goods Sold1405573CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-300642TotalRevenueColumn
Related Or Exempt Function Income-300642RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
FORFEITURE REVENUE90009931257$31,257
GUEST MEALS7210002661$2,661
FieldValueIRS element (for citing)
Total Other Revenue33918TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column8804489TotalRevenueColumn
Related Or Exempt Function Income8758086RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$36,248ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total181299Total
Program Services155736ProgramServices
Management And General25563ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4043998Total
Program Services3597465ProgramServices
Management And General446533ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total42796Total
Program Services38495ProgramServices
Management And General4301ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total379140Total
Program Services344668ProgramServices
Management And General34472ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total322689Total
Program Services290258ProgramServices
Management And General32431ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total36751Total
Management And General36751ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total69785Total
Management And General69785ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total51887Total
Program Services8377ProgramServices
Management And General43510ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total48334Total
Management And General48334ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total342421Total
Program Services340561ProgramServices
Management And General1860ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total2119Total
Management And General2119ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total50970Total
Program Services50970ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total326208Total
Program Services267943ProgramServices
Management And General58265ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total89445Total
Program Services89445ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCHASED SERVICES AND2357067229434062727
IMPAIRMENT OF INVENTORY11191441119144
INVENTORY HOLDING COSTS291263291263
DUES AND SUBSCRIPTIONS3357033570
BAD DEBT EXPENSE2416124161

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total24135Total
Program Services2941ProgramServices
Management And General21194ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9837182Total
Program Services8891606ProgramServices
Management And General945576ManagementAndGeneral
Fundraising0Fundraising
FieldValueIRS element (for citing)
Joint CostsXJointCosts

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY277007BOY
EOY293922EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY541974BOY
EOY801660EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2982751BOY
EOY3051860EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY36134BOY
EOY40457EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY151159BOY
EOY89276EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis10336763LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec7598031LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2928563BOY
EOY2738732EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4750074BOY
EOY2241862EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11667662BOY
EOY9257769EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1926396BOY
EOY1861044EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY365453BOY
EOY387845EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4968227BOY
EOY3647123EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY13136BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7273212BOY
EOY5896012EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4394450BOY
EOY3361757EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4394450BOY
EOY3361757EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11667662BOY
EOY9257769EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-1032693ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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 Years74840CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years31043CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years70357CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10334CurrentTaxYearMinus1Year
Current Tax Year10155CurrentTaxYear
Total196729Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7231910CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14428203CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9825942CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8894962CurrentTaxYearMinus1Year
Current Tax Year10163659CurrentTaxYear
Total50544676Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7306750CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14459246CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9896299CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8905296CurrentTaxYearMinus1Year
Current Tax Year10173814CurrentTaxYear
Total50741405Total

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 Total50950741405PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years24105CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years959CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3865CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1681CurrentTaxYearMinus1Year
Current Tax Year2521CurrentTaxYear
Total33131Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years24105CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years959CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3865CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1681CurrentTaxYearMinus1Year
Current Tax Year2521CurrentTaxYear
Total33131Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4664CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4585CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years99376CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4564CurrentTaxYearMinus1Year
Current Tax Year33918CurrentTaxYear
Total147107Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7335519CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14464790CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9999540CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8911541CurrentTaxYearMinus1Year
Current Tax Year10210253CurrentTaxYear
Total50921643Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99650PublicSupportPercentage509
Prior Year Support Percentage0.99660PriorYearSupportPercentage
Investment Income Percentage0.00070InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00090PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis254703OtherCostOrOtherBasis
Book Value254703BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6904711OtherCostOrOtherBasis
Depreciation4929357Depreciation
Book Value1975354BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1924474OtherCostOrOtherBasis
Depreciation1715902Depreciation
Book Value208572BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1252875OtherCostOrOtherBasis
Depreciation952772Depreciation
Book Value300103BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2738732TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
BOND FEES NET OF ACCUMULATED DEPREC17333
LANDMARK SQUARE PROJECT2224529
FieldValueIRS element (for citing)
Total Book Value Other Assets2241862TotalBookValueOtherAssets
Total Revenue8804489TotalRevenue
Total Expenses9837182TotalExpenses
Excess Or Deficit For Year-1032693ExcessOrDeficitForYear
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS-1032693ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt9073873TotRevenueEtcAuditedFinclStmt
Other Revenues300641OtherRevenues
Revenue Not Rptd F990300641RevenueNotRptdF990
Revenue Subtotal8773232RevenueSubtotal
Other Revenues Not Included31257OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt31257RevenueNotRptdOnFinStmt
Total Revenue Per Form9908804489TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt10106566TotExpensesEtcAuditedFinclStmt
Other Expenses Included300641OtherExpensesIncluded
Expenses Not Rptd F990300641ExpensesNotRptdF990
Expenses Subtotal9805925ExpensesSubtotal
Other Expenses Not Included31257OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt31257ExpensesNotRptdOnFinStmt
Total Expenses Per Form9909837182TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierExplanationExplanation
PART XII, LINE 2D - OTHER ADJUSTMENTS:LOSS FROM SALES OF INVENTORY INCLUDED ON 990 PAGE 9, LINE 10C 300,641.
PART XII, LINE 4B - OTHER ADJUSTMENTS:FORFEITURES 31,257.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:SALE OF INVENTORY INLOSS FROM SALES OF INVENTOCLUDED ON 990 PAGE 9, LINE 10C 300,641.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:FORFEITURES 31,257.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonMICHAEL ROTHNamePerson
FieldValueIRS element (for citing)
RelationshipPARTNER AT WURTZ, ROTH, BASLER, AND BROCKRelationship
Amount Of Transaction1209AmountOfTransaction
Description Of TransactionSHEBOYGAN SENIOR COMMUNITY, INC. USED WURTZ, ROTH, BASLER, AND BROCK FOR LAW SERVICESDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 4THE NUMBER OF DIRECTORS CONSITITUING THE BOARD OF DIRECTORS WAS CHANGED FROM AT LEAST 15 BUT NO MORE THAN 25 TO AT LEAST 11 BUT NO MORE THAN 15. AT LEAST 3 OF THE DIRECTORS SHALL BE MEMBERS OF THE UNITED METHODIST CHURCH INSTEAD OF AT LEAST 6. IT IS NO LONGER NESSESSARY FOR THE VICE PRESIDENT TO INCLUDE THE CHAIRS OF THE STRATEGIC PLANNING, SERVICES AND FINANCE COMMITTEES. THE EXECUTIVE COMMITTEE MEMBERS WAS CHANGED FROM CONSISTING OF THE PRESIDENT, 3 VICE PRESIDENTS, SECRETARY/TREASURER AND THE IMMEDIATE PAST PRESIDENT OF THE BOARD TO CONSISTING OF THE PRESIDENT, VICE PRESIDENT AND THE SECRETARY/TREASURER. THE AMOUNT OF EXPENDITURES AND TRANSFERS OF PROPERTY THE COMMITTEE CAN CONDUCT BUSINESS AND AFFAIRS OF THE CORPORATION AND CARRY ON CORPORATE OPERATIONS CHANGED FROM UP TO $10,000 TO UP TO $30,000. THE SERVICE COMMITTEE WENT FROM BEING COMPOSED OF AT LEAST 5 MEMBERS TO AT LEAST 3 MEMBERS. THE CHAIRPERSON NO LONGER HAS TO BE THE VICE PRESIDENT OF SERVICES. THE STRATEGIC PLANNING COMMITTEE CHANGED FROM BEING COMPOSED OF AT LEAST 5 MEMBERS TO AT LEAST 3 MEMBERS.
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.
A NEW CONFLICT OF INTEREST POLICY IS FILLED OUT ON AN ANNUAL BASIS.FORM 990, PART VI, SECTION B, LINE 12C
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 B, LINE 15A
THESE DOCUMENTS ARE AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT.FROM 990, PART XI, LINE 2C:

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

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1LSQ CONDO OWNER'S ASSOCIATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1930 NORTH 6TH STREETAddressLine1
CitySHEBOYGANCity
StateWIState
ZIP Code53081ZIPCode
FieldValueIRS element (for citing)
EIN261895173EIN
Primary ActivityCONDOMINIUM MANAGEMENT ASSOCIATION AND MANAGING CONDOMINIUMSPrimaryActivity
Legal Domicile StateWILegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1BOARD OF DIRECTORSBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of Total Income-38718ShareOfTotalIncome
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
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 Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
LSQ CONDO OWNER'S ASSOCIATION
O38718ACTUAL LOSS INCURRED
SHEBOYGAN SENIOR COMMUNITY FOUNDATION
E1243192ACTUAL BALANCE OUTSTANDING

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.