Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
CEDAR CREST INC
Employer identification number
39-1025444
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
191,326
55,712
91,997
90,513
155,635
585,183
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
12,070,052
12,953,303
13,268,628
14,013,379
14,200,822
66,506,184
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
12,261,378
13,009,015
13,360,625
14,103,892
14,356,457
67,091,367
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
90,850
90,850
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
0
c
Add lines 7a and 7b..
90,850
90,850
8
Public support (Subtract line 7c from line 6.)
67,000,517
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
12,261,378
13,009,015
13,360,625
14,103,892
14,356,457
67,091,367
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
199,638
165,855
67,349
46,579
47,841
527,262
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
322
322
c
Add lines 10a and 10b.
199,638
165,855
67,349
46,901
47,841
527,584
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
12,461,016
13,174,870
13,427,974
14,150,793
14,404,298
67,618,951
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
99.090 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
98.770 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.780 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
1.090 %
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
CEDAR CREST INC
Employer identification number
39-1025444
Return Reference
Explanation
FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:
CEDAR CREST'S MISSION IS TO "ENRICH THE QUALITY OF LIFE FOR SENIOR ADULTS AT ALL LEVELS OF INDEPENDENCE, GUIDED BY A SPIRITUALLY BASED, NOT-FOR-PROFIT CULTURE THAT FOSTERS COMPASSION AND CARE." AS A SPIRTUALLY BASED ORGANIZATION, WE BELIEVE EACH PERSON WHETHER RESIDENT, STAFF, VOLUNTEER, OR NEIGHBOR IS A PRECIOUS GIFT TO BE TREATED WITH RESPECT IN BODY, MIND, AND SPIRIT. WE BELIEVE SENIOR ADULTS DESERVE TO LIVE THEIR FULL LIFE WITH DIGNITY. THEREFORE, WE ARE DEDICATED TO TREATING EACH PERSON WHO LIVES AT CEDAR CREST AS AN IMPORTANT AND UNIQUE INDIVIDUAL AND TO PROVIDE THE SUPPORT NEEDED TO ENHANCE THE LIVES OF OUR RESIDENTS. THROUGH INTEGRITY AND PROFESSIONNALISM, CLEAR AND INCLUSIVE COMMUNICATION, A DIVERSE AND DYNAMIC ARRAY OF LIVING AND SERVICE OPTIONS, A RESPECT FOR INDIVIDUAL EXPERIENCES AND CHOICES, AND A CORPORATE CULTURE OF EXCELLENT CUSTOMER SERVICE, WE STRIVE TO HELP EACH RESIDENT ACHIEVE THE HIGHEST QUALITY OF LIFE POSSIBLE.
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS:
CEDAR VIEW IS A SKILLED NURSING FACILITY PROVIDING 24 HOUR COMPLETE CARE OF EACH RESIDENT INCLUDING BUT NOT LIMITED TO: FEEDING, THREE MEALS PER DAY PLUS SNACKS BASED ON INDIVIDUAL DIET NEEDS, NUTRITION MANAGEMENT, BATHING AND DRESSING, LAUNDRY, HOUSEKEEPING, TOILETING, MEDICATIONS ADMINISTRATION AND MANAGEMENT, DRESSING CHANGES, RESTORATIVE PROGRAM BASED ON THE INDIVIDUAL RESIDENT'S NEEDS, REHABILITATION SERVICES INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, ACTIVITIES MEETING THE INDIVIDUAL NEEDS OF EACH RESIDENT, TUBE FEEDING, DEVELOPMENT OF AND IMPLEMENTING FOR EACH RESIDENT A COMPLETE INDIVIDUAL CARE PLAN, SCHEDULING OF MEDICAL APPOINTMENTS, TRANSPORTATION TO MEDICAL APPOINTMENTS, COORDINATING CARE UNDER THE DIRECTION OF THE RESIDENT'S DOCTOR. THE PROGRAM IS LICENSED AS A 95 BED SKILLED NURSING FACILITY. THE PROGRAM IS MEDICARE AND MEDICAID CERTIFIED AND PROVIDES SERVICES TO RESIDENTS WHO PAY PRIVATELY AS WELL AS THOSE RESIDENTS WHO ARE ENTITLED TO MEDICARE AND MEDICAID BENEFITS. A TOTAL OF 32,671 RESIDENT CARE DAYS WERE PROVIDED.
FORM 990, PART III, LINE 4B, PROGRAM SERVICE ACCOMPLISHMENTS:
WATERFORD PLACE APARTMENTS ARE REGISTERED WITH THE STATE OF WISCONSIN AS A RESIDENTIAL CARE APARTMENT COMPLEX (RCAC). THIS LICENSURE ALLOWS RESIDENTS WHO HAVE CHOSEN AN INDEPENDENT LIVING SETTING WITHIN THE CEDAR CREST COMMUNITY TO "AGE IN PLACE" THROUGH THE PROVISION OF SERVICES IN THEIR APARTMENT. THE SERVICES PROVIDE FOR UP TO 28 HOURS OF NURSING AND PERSONAL CARE SERVICES ARE SCHEDULED AND ARE BASED ON NURSING ASSESSMENT AND RISK AGREEMENT BETWEEN THE RESIDENT AND CEDAR CREST. THERE ARE 105 APARTMENTS UNDER THE RCAC REGISTRATION WITH APPROXIMATELY 31,897 DAYS OF SERVICE BEING PROVIDED TO THE RESIDENTS.
FORM 990, PART III, LINE 4C, PROGRAM SERVICE ACCOMPLISHMENTS:
TERRACE RIDGE ASSISTED LIVING IS A 44 BED COMMUNITY BASED ON RESIDENTIAL FACILITY (CBRF) WHICH IS LICENSED BY THE STATE OF WISCONSIN. THE PROGRAM PROVIDES SERVICES TO RESIDENTS WHO REQUIRE LIMITED NURSING CARE BUT NEED VARYING LEVELS OF ASSISTANCE WITH DAILY LIVING ACTIVITIES. THE PROGRAM IS STAFFED 24 HOURS PER DAY, SEVEN DAYS A WEEK WITH PERSONAL CARE WORKERS AND CERTIFIED NURSING ASSISTANTS. IT IS ALSO STAFFED WITH A FULL TIME RN ASSISTED LIVING MANAGER. UP TO 3 HOURS OF NURSING CARE PER WEEK IS PROVIDED (DIRECTLY BY AN RN) AND UNLIMITED NUMBER OF HOURS OF CARE WITH DAILY LIVING ACTIVITIES. THIS CARE INCLUDES BATHING AND DRESSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, ACTIVITIES MEETING THE NEEDS OF EACH RESIDENT, FEEDING, THREE MEALS PER DAY AND OTHER NUTRITIONAL NEEDS BASED ON THE INDIVIDUAL RESIDENT, LAUNDRY, HOUSEKEEPING, TOILETING, DRESSING CHANGES, MEDICATION ADMINISTRATION AND MANAGEMENT, SCHEDULING OF MEDICAL APPOINTMENTS, TRANSPORTATION TO MEDICAL APPOINTMENTS, COORDINATING CARE UNDER THE DIRECTION OF THE RESIDENT'S DOCTOR AS WELL AS OTHER UNIQUE NEEDS OF EACH INDIVIDUAL RESIDENT. A TOTAL OF 15,487 RESIDENT CARE DAYS WERE PROVIDED.
FORM 990, PART III, LINE 4D, OTHER PROGRAM SERVICES:
THE CEDAR CREST MEMORY CARE UNIT IS A 12 BED LICENSED CBRF PROVIDING SERVICES TO THOSE INDIVIDUALS WHO HAVE BEEN DIAGNOSED WITH ALZHEIMER OR OTHER DEMENTIA RELATED DISEASES. THE PROGRAM PROVIDES SERVICES TO RESIDENTS WHO REQUIRE LIMITED NURSING CARE BUT NEED ASSISTANCE WITH DAILY LIVING ACTIVITIES. THE PROGRAM IS STAFFED 24 HOURS PER DAY, SEVEN DAYS A WEEK WITH PERSONAL CARE WORKERS AND CERTIFIED NURSING ASSISTANTS. IT IS ALSO STAFFED WITH AN RN MEMORY CARE MANAGER. UP TO 3 HOURS OF NURSING CARE PER WEEK IS PROVIDED (DIRECTLY BY AN RN) AND UNLIMITED NUMBER OF HOURS OF CARE WITH DAILY LIVING ACTIVITIES. THIS CARE INCLUDES BATHING AND DRESSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, ACTIVITIES MEETING THE NEEDS OF EACH RESIDENT, FEEDING, THREE MEALS PER DAY AND OTHER NUTRITIONAL NEEDS BASED ON THE INDIVIDUAL RESIDENT, LAUNDRY, HOUSEKEEPING, TOILETING, DRESSING CHANGES, MEDICATION ADMINISTRATION AND MANAGEMENT, SCHEDULING OF MEDICAL APPOINTMENTS, TRANSPORTATION TO MEDICAL APPOINTMENTS, COORDINATING CARE UNDER THE DIRECTION OF THE RESIDENT'S DOCTOR AS WELL AS OTHER UNIQUE NEEDS OF EACH INDIVIDUAL RESIDENT. A TOTAL OF 4,322 RESIDENT CARE DAYS WERE PROVIDED.
FORM 990, PART VI, SECTION B, LINE 11
THE AUDIT COMMITTEE REVIEWS THE FORM 990 IN DETAIL WITH MANAGEMENT PRIOR TO FILING THE 990. SUBSEQUENT TO THE FILING, THE 990 IS REVIEWED WITH THE FULL BOARD AND COPIES OF THE 990 ARE MADE AVAILABLE TO EACH BOARD MEMBER.
FORM 990, PART VI, SECTION B, LINE 12C
THE CONFLICT OF INTEREST POLICY IS REVIEWED WITH EACH NEW BOARD MEMEBER AND THE NEW BOARD MEMBER SIGNS A CONFLICT OF INTEREST STATEMENT BEFORE ATTENDING THE FIRST BOARD MEETING. ANNUALLY THE CONFLICT OF INTEREST POLICY IS REVIEWED WITH ALL BOARD MEMBERS AND MANAGERS AND AN UNDATED CONFLICT OF INTEREST STATEMENT IS REQUIRED TO BE COMPLETED BY ALL BOARD MEMBERS AND MANAGERS. THE CONFLICT OF INTEREST STATEMENTS ARE SUMMARIZED AND REVIEWED BY THE GOVERNANCE COMMITTEE AND ANY CONFLICTS ARE REPORTED TO THE BOARD OF DIRECTORS BY THE GOVERNANCE COMMITTEE. IF A CONFLICT OF INTEREST IS DISCOVERED THAT WAS NOT DISCLOSED ON THE CONFLICT OF INTEREST STATEMENT, THE ISSUE IS DIRECTED TO THE GOVERNANCE COMMITTEE FOR RESOLUTION.
FORM 990, PART VI, SECTION B, LINE 15
EACH YEAR THE EXECUTIVE COMMITTEE GATHERS MARKET DATA FOR DETERMINING COMPENSATION OF THE CHIEF EXECUTIVE OFFICER. THIS INCLUDES, BUT IS NOT LIMITED TO, BENCHMARKS OF COMPENSATION FOR SIMILAR ORGANIZATIONS, PROVIDED FROM INDEPENDENT SOURCES. BASED ON THIS INFORMATION AND THE RESULTS OF THE PERFORMANCE EVALUATION, THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS SETS AND APPROVES THE COMENSATION FOR THE CHIEF EXECUTIVE OFFICER FOR THE YEAR AND DOCUMENTS THEIR APPROVAL IN WRITING. THIS PROCESS APPLIES ONLY TO THE CHIEF EXECUTIVE OFFICER. CEDAR CREST HAS NO OTHER OFFICERS OR KEY EMPLOYEES.
FORM 990, PART VI, SECTION C, LINE 19
FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICTS OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO IRC SECTION 6104. THESE DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC ON RECEIPT OF A WRITTEN REQUEST.
FORM 990, PART VIII, LINE 11D, LOSS ON EXTINGUISHMENT OF DEBT
IN DECEMBER 2013, SERIES 2006 BONDS WERE REFUNDED WITH FUNDS OBTAINED FROM THE ISSUANCE OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY (WHEFA) ADJUSTABLE RATE REFUNDING REVENUE BONDS, SERIES 2013, FOR THE PURPOSES OF REORGANIZING THE EXISTING DEBT STRUCTURE TO REDUCE LONG-TERM INTEREST EXPENSE. THE REFUNDING OF SERIES 2006 BONDS IS CONSIDERED A DEBT EXTINGUISHMENT. THE DIFFERENCE BETWEEN THE REACQUISITION PRICE OF DEBT AND THE NET CARRYING VALUE AMOUNT OF THE EXTINGUISHED DEBT, ALONG WITH FEES ASSOCIATED THE THE EXTINGUISHMENT, HAS BEEN RECOGNIZED CURRENTLY IN INCOME AS A LOSS OF $243,083.
FORM 990, PART XI, LINE 9:
2012 INCOME FROM HPS LLC 328.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.