2020-11-16T11:52:11-06:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2019-01-01 391081800 EVERGREEN RETIREMENT COMMUNITY INC EVER 9202332340 1130 NORTH WESTFIELD STREET OSHKOSH WI 549023217 BILLIE JO HIGGINS TREASURER 9202372184 2020-10-26 1 KIMBERLY ANDERSON P00188889 6086628600 2020-10-26 67.137.57.251 2020-10-26 12:32:51 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 3FF511856DDCEB4119B81A2A2A82F27319C177AE 2019 2021-01-29 14:40:06Z KENNETH A ARNESON 1130 NORTH WESTFIELD STREET OSHKOSH WI 549023217 20365360 0 X WWW.EVERGREENOSHKOSH.COM X 1965 WI GUIDED BY CHRISTIAN IDEALS, WE STRIVE TO PROVIDE EXCEPTIONAL LIVING ENVIRONMENTS, SERVICES AND EXPERIENCES FOR PEOPLE 55 AND OLDER. 18 18 482 155 0 0 583871 659528 18517998 19137849 -81834 0 554976 567983 19575011 20365360 0 0 0 0 9701091 10046794 0 0 0 8887363 9324311 18588454 19371105 986557 994255 42128199 42525878 28566898 27962143 13561301 14563735 X GUIDED BY CHRISTIAN IDEALS, WE STRIVE TO PROVIDE EXCEPTIONAL LIVING ENVIRONMENTS, SERVICES AND EXPERIENCES FOR PEOPLE 55 AND OLDER. 0 0 15811728 19705832 EVERGREEN IS A NONPROFIT CONTINUING CARE RETIREMENT COMMUNITY (CCRC) SERVING OLDER ADULTS, AGES 55 AND OLDER. IDEAL FOR THOSE LOOKING FOR A LIFESTYLE OF CHOICE, FREEDOM, SAFETY, COMMUNITY AND VALUE, EVERGREEN IS MORE THAN JUST A SENIOR LIVING COMMUNITY.EVERGREEN'S 35-ACRE CAMPUS IS NOT ONLY HOME TO ALMOST 300 RESIDENTS, BUT IT IS ALSO A DESTINATION FOR FAMILIES, COMMUNITY MEMBERS, VOLUNTEERS, NONPROFIT GROUPS AND OTHER VISITORS.LOCATED IN A PLEASANT RESIDENTIAL NEIGHBORHOOD IN OSHKOSH, WISCONSIN AMONG BEAUTIFUL, NATURAL SURROUNDINGS AND BORDERED BY OUR OWN OAK SAVANNA WOODLANDS, EVERGREEN PROVIDES LIVELY OPPORTUNITIES FOR YOU AND YOUR FRIENDS TO LIVE AS YOU CHOOSE. CHOOSE FROM THREE STYLES OF INDEPENDENT LIVING ACCOMMODATIONS, FOUR LEVELS OF ASSISTED LIVING, SHORT-TERM REHAB AND POST SURGICAL CARE, LONG-TERM SKILLED NURSING, OR EVERGREEN AT HOME SERVICES TO MEET YOUR UNIQUE NEEDS.LIFE ENRICHMENT ABOUNDS AT EVERGREEN. THERAPEUTIC SWIMMING POOLS, AN AEROBIC STUDIO, LAPIDARY SHOP, AND SUPPERS WITH THE CHEF ARE JUST A FEW OF THE MANY OPPORTUNITIES THAT ENCOURAGE ACTIVE LIFESTYLES. PARTNERSHIPS WITH THE UNIVERSITY OF WISCONSIN OSHKOSH, LEARNING IN RETIREMENT AND THE OSHKOSH GALLERY WALK ALSO PROVIDE ENTERTAINING AND FULFILLING EXPERIENCES AND ENSURE THAT NO TWO DAYS ARE THE SAME. AT EVERGREEN, POSSIBILITIES AWAIT. 15811728 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 85 0 1 482 1 0 0 0 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 WI X BILLIE JO HIGGINS 9202372184 1130 NORTH WESTFIELD STREET OSHKOSH WI 549023217 JIM CHITWOOD DIRECTOR 1.00 X 0 0 0 GINI DAVIS DIRECTOR 1.00 X 0 0 0 ANN TULIP DIRECTOR 1.00 X 0 0 0 STEVE DUNN DIRECTOR 1.00 X 0 0 0 VERNICE HAASE CHAIRMAN 1.00 X X 0 0 0 ELIZABETH HARTMAN DIRECTOR 1.00 X 0 0 0 JOHN HINTZE DIRECTOR 1.00 X 0 0 0 TONY RENNING DIRECTOR 1.00 X 0 0 0 FRED LILLY DIRECTOR 1.00 X 0 0 0 SANDY MUINDE DIRECTOR 1.00 X 0 0 0 DR JOHN NEWMAN DIRECTOR 1.00 X 0 0 0 RICK PICARD DIRECTOR 1.00 X 0 0 0 TOM RAMSEY DIRECTOR 1.00 X 0 0 0 BARBARA RAU VICE CHAIR 1.00 X X 0 0 0 LUELLA REMMEL DIRECTOR 1.00 X 0 0 0 JOHN SCHATZ DIRECTOR 1.00 X 0 0 0 CATHY WEDIGAND DIRECTOR 1.00 X 0 0 0 MIKE GREY DIRECTOR 1.00 X 0 0 0 LISA RUIZ EXECUTIVE ASSISTANT/SECRET 40.00 X 16166 0 8179 KEN ARNESON PRESIDENT/CEO 40.00 1.00 X 233612 0 16085 JOHN KRUEGER VP FINANCE & IS/TREASURER 40.00 1.00 X 121581 0 18339 BROOKE KNOLL EXECUTIVE ASSISTANT/SECRET 40.00 X 17292 0 13435 388651 0 56038 2 0 1 0 REHABCARE GROUP INC BOX 277365 ATLANTA GA 303847365 THERAPY SERVICES 908414 NEW HORIZON FOODS PO BOX 860246 MINNEAPOLIS MN 554860246 DINING SERVICES 828980 HEALTHCARE SERVICES GROUP PO BOX 829677 PHILADELPHIA PA 191829677 HOUSEKEEPING SERVICES 642626 BEEZ ELECTRIC INC PO BOX 2332 OSHKOSH WI 549032332 ELECTRICIAN SERVICES 421064 PACKER VALLEY BUILDERS INC 2277 CLAIRVILLE ROAD OSHKOSH WI 54904 CARPENTRY SERVICES 229774 10 659528 659528 RESIDENT SERVICE FEES 623000 18413552 18413552 MANAGEMENT FEE INCOME 900099 724297 724297 19137849 OTHER SERVICE REVENUE 900099 567983 567983 567983 20365360 19705832 0 0 X 444689 367717 76972 7748786 6407537 1341249 317972 264117 53855 942840 783149 159691 592507 492153 100354 5707 5707 43526 860 42666 2871130 1947132 923998 131061 108447 22614 208246 172313 35933 25122 20787 4335 793301 656417 136884 13583 11239 2344 96109 79525 16584 671730 671730 2242936 1977183 265753 155305 128507 26798 FOOD SUPPLIES 1222557 1011606 210951 RESIDENT SUPPLIES 265983 220088 45895 GENERAL SUPPLIES 265660 219821 45839 BAD DEBTS 75000 75000 237355 196400 40955 19371105 15811728 3559377 0 5915065 6031344 224541 836880 1631883 2159101 14196 100977 88417 200150 302579 62639322 30046436 33544214 32592886 74998 274998 436371 225477 42128199 42525878 2356508 2220731 5208483 5712067 20937063 19972682 9297 9295 55547 47368 28566898 27962143 X 13561301 14563735 13561301 14563735 42128199 42525878 994255 8179 0 X 0 1 X 1 0 X 561007 499592 2058362 583871 659528 4362360 15145788 15728646 16633243 18517998 19137849 85163524 15706795 16228238 18691605 19101869 19797377 89525884 0 0 0 89525884 582579 484101 494089 554976 567983 2683728 16289374 16712339 19185694 19656845 20365360 92209612 0.97090 0.96990 0.00000 0.00080 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 7448232 448 1327688 60892 37163 8677264 7918740 62563 -433229 60561 39281 7448232 6425527 677925 898650 48964 34398 7918740 6129413 7810 363749 49744 25701 6425527 6358425 -6352 -137017 60173 25570 6129413 0.42360 0.55380 0.02260 0 1 1 414939 414939 44684443 17156676 27527767 2330882 1303587 1027295 15139057 11586173 3552884 70001 70001 32592886 LIABILITY ON INTEREST SWAP AGREEMENT 47368 47368 PART IV, LINE 2B: FOR 2019, THERE WAS A RESIDENT FUNDS SAVINGS ACCOUNT IN THE AMOUNT OF $6,454 AND A RESIDENT CHECKING FUND WITH A BALANCE OF $2,941. PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD BY THE RELATED FOUNDATION FOR THE BENEVOLENT NEEDS FOR RESIDENTS OF EVERGREEN RETIREMENT COMMUNITY WHO HAVE EXHAUSTED THEIR PERSONAL RESOURCES, WOODLANDS PRESERVATION, LIFECARE LEARNING, PASTORAL CARE, CREATIVE ARTS, AND GROUNDS BEAUTIFICATION. 1 X X 0 0 0 0 0 1 0 0 0 KEN ARNESON PRESIDENT/CEO 223611 0 10001 0 0 0 0 0 16085 0 249697 0 0 0 PART I, LINE 3 THE ORGANIZATIONAL PERFORMANCE COMMITTEE (OPC) OF THE BOARD IS RESPONSIBLE FOR CONDUCTING THE PERFORMANCE REVIEW OF THE CEO AND MAKING A WAGE RECOMMENDATION TO THE FULL BOARD OF DIRECTORS. THE OPC IS PROVIDED COMPARATIVE WAGE DATA ANNUALLY BY THE VICE PRESIDENT OF HUMAN RESOURCES. THE REVIEW PROCESS IS DOCUMENTED IN EXECUTIVE SESSION MINUTES. PART I, LINE 6 PRESIDENT/CEO (KEN ARNESON), VP OF FINANCE/IS & TREASURER (JOHN KRUEGER), EXECUTIVE ASSISTANT/SECRETARY (LISA RUIZ) AND EXECUTIVE ASSISTANT/SECRETARY (BROOKE KNOLL) OF EVERGREEN RETIREMENT COMMUNITY, AS MEMBERS OF THE MANAGEMENT TEAM, RECEIVE AN ANNUAL BONUS, PART OF WHICH RELATES TO THE NET INCOME OF THE ORGANIZATION. A ELDERLY HOUSING AUTHORITY OF THE CITY OF OSHKOSH 391251777 2003-11-25 6600000 CONSTRUCTION OF SKILLED NURSING FACILITY AND FITNESS & AQUATIC CENTER 0 0 0 B WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 2016-12-01 14150000 CONSTRUCTION OF 62 APARTMENTS AND A WORSHIP AND PERFORMING ARTS CENTER 0 0 0 C WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 2013-12-20 7000000 CAMPUS REMODEL (REPOSITIONING) 0 0 0 A 4506000 6600000 6600000 2004 1 0 1 1 B 905452 14150000 12149557 2000443 2016 0 0 0 1 C 166377 7000000 7000000 2014 0 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 1 A 0 0 1 0 0 1 ASSOCIATED BANK NA 9.583333300000 0 0 0 0 0 B 0 0 0 1 1 0 0 0 1 C 0 0 0 1 1 0 0 0 1 A 0 B 0 C 0 WILLIAM KRUEGER BROTHER TO JOHN KRUEGER, BOARD TREASURER 62544 EMPLOYEE 0 KEALI WINCHELL DAUGHTER TO VIRGINIA DAVIS, BOARD MEMBER 55192 EMPLOYEE 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIR AND VICE CHAIR OF THE BOARD AND THE CHAIRS OF THE THREE OTHER STANDING BOARD COMMITTEES. THE CHAIR SHALL SERVE AS THE CHAIR OF THE EXECUTIVE COMMITTEE. A QUORUM SHALL CONSIST OF THREE MEMBERS. THE COMMITTEE SHALL MEET AT THE CALL OF THE CHAIR OR ANY TWO EXECUTIVE COMMITTEE MEMBERS. THE COMMITTEE SHALL HAVE FULL AUTHORITY TO ACT ON BEHALF OF THE BOARD BETWEEN MEETINGS OF THE BOARD, EXCEPT THE ELECTION OF OFFICERS OR THE AUTHORITY TO DECLARE OR FILL ANY VACANCY ON THE BOARD. ALL ACTIONS OF THE COMMITTEE SHALL BE REPORTED AT THE NEXT REGULARLY SCHEDULED MEETING OF THE BOARD. THE COMMITTEE SHALL PERFORM SUCH OTHER FUNCTIONS AS MAY BE DELEGATED TO IT BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S TREASURER WILL REVIEW THE 990 IN DETAIL. AN ELECTRONIC VERSION OF THE FORM 990 WILL BE POSTED ON THE BOARD WEB PAGE WITH MEMBERS GIVEN THE OPPORTUNITY TO REVIEW IT PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY THAT APPLIES TO ALL EMPLOYEES AND IT HAS A CODE OF CONDUCT POLICY THAT APPLIES TO ALL BOARD MEMBERS. BOARD MEMBERS ARE REQUIRED TO ANNUALLY DISCLOSE ANY CONFLICTS OF INTEREST AND TO CONDUCT BUSINESS WITH EVERGREEN IN A MANNER THAT SUPPORTS THE INTERESTS OF EVERGREEN AND AVOIDS UNFAIR PERSONAL ADVANTAGE. NON-COMPLIANCE WITH THE CODE OF CONDUCT MAY RESULT IN REMOVAL FROM THE BOARD FOLLOWING AN OPPORTUNITY FOR EXPLANATION TO THE FULL BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATIONAL PERFORMANCE COMMITTEE (OPC) OF THE BOARD IS RESPONSIBLE FOR CONDUCTING THE PERFORMANCE REVIEW OF THE CEO AND MAKING A WAGE RECOMMENDATION TO THE FULL BOARD OF DIRECTORS. THE OPC IS PROVIDED COMPARATIVE WAGE DATA ANNUALLY BY THE VICE PRESIDENT OF HUMAN RESOURCES. THE REVIEW PROCESS IS DOCUMENTED IN EXECUTIVE SESSION MINUTES. VICE PRESIDENTS ARE REVIEWED BY THE PRESIDENT/CEO. THE SECRETARY OF THE BOARD IS THE EXECUTIVE ASSISTANT TO THE PRESIDENT/CEO AND IS REVIEWED BY THE PRESIDENT/CEO. PERIODIC WAGE & SALARY SURVEYS ARE CONDUCTED TO ASSURE COMPENSATION IS COMPARABLE TO INDUSTRY/AREA MARKET. FORMS ARE USED TO DOCUMENT ACCOMPLISHMENTS. FORM 990, PART VI, SECTION C, LINE 19 EVERGREEN RETIREMENT COMMUNITY, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FORM 990 AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. REQUESTED DOCUMENTS ARE PROVIDED WITHIN A REASONABLE TIME FRAME. FORM 990, PART IX, LINE 11G CONTRACTS AND OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,947,132. MANAGEMENT AND GENERAL EXPENSES 923,998. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,871,130. EVERGREEN FOUNDATION INC 1130 NORTH WESTFIELD STREET OSHKOSH WI 54902 391388991 FUNDRAISING WI 501(C)(3) LINE 7 N/A 0 EVERGREEN VILLAGE INC 1130 NORTH WESTFIELD STREET OSHKOSH WI 54901 391505337 CO-OPERATIVE WI N/A C 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 1 0 0