Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 91,997 | 90,513 | 155,635 | 107,452 | 61,808 | 507,405 |
| 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...... | 13,268,628 | 13,906,694 | 14,200,822 | 14,488,003 | 14,040,093 | 69,904,240 |
| 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. | 13,360,625 | 13,997,207 | 14,356,457 | 14,595,455 | 14,101,901 | 70,411,645 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| 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.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 70,411,645 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 13,360,625 | 13,997,207 | 14,356,457 | 14,595,455 | 14,101,901 | 70,411,645 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 67,349 | 46,579 | 47,841 | 50,399 | 49,704 | 261,872 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 322 | 322 | ||||
| c | Add lines 10a and 10b. | 67,349 | 46,901 | 47,841 | 50,399 | 49,704 | 262,194 |
| 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 13,427,974 | 14,044,108 | 14,404,298 | 14,645,854 | 14,151,605 | 70,673,839 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2015 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| 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 83 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 28,635 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 107 APARTMENTS UNDER THE RCAC REGISTRATION WITH APPROXIMATELY 31,731 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 15,292 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 4,304 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 XI, LINE 9: | RELATED PARTY DUE TO/FROM 25,000. |
| Software ID: | |
| Software Version: |