TRANSITIONS AT HOME INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- TRANSITIONS AT HOME INC (EIN 20-5835453)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-08-13
- IRS object ID
- 201342259349302889
- Schema version
- 2012v2.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-13T16:06:49-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810385940 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANDERSON ZURMUEHLEN & CO PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 748 | AddressLine1 |
| City | BUTTE | City |
| State | MT | State |
| ZIP Code | 59703 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 205835453 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EDGERTON CARE CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | EDGE | NameControl |
| Phone | 6088841332 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 313 STOUGHTON ROAD | AddressLine1 |
| City | EDGERTON | City |
| State | WI | State |
| ZIP Code | 53534 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ANDY KERWIN | Name |
| Title | SECRETARY | Title |
| Phone | 6088841332 | Phone |
| Date Signed | 2013-08-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES E WOY | Name |
| PTIN | P00102054 | PTIN |
| Phone | 4067820451 | Phone |
| Date Prepared | 2013-08-13 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ANDY KERWIN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 133 MAPLE BLUFF ROAD N | AddressLine1 |
| City | STEVENS POINT | City |
| State | WI | State |
| ZIP Code | 544829254 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 5197918 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.EDGERTONCARECENTER.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2006 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | LONG-TERM CARE | ActivityOrMissionDescription |
| Termination Or Contraction | X | TerminationOrContraction |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 147 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 36774 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 222003 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 4047600 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 4974567 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 801 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1348 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 28121 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 4113296 | TotalRevenuePriorYear |
| Total Revenue Current Year | 5197918 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 807024 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 2816418 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 2620988 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1288171 | OtherExpensePriorYear |
| Other Expenses Current Year | 2515103 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 4104589 | TotalExpensesPriorYear |
| Total Expenses Current Year | 5943115 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 8707 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -745197 | RevenuesLessExpensesCY |
| Total Assets BOY | 1117754 | TotalAssetsBOY |
| Total Assets EOY | 0 | TotalAssetsEOY |
| Total Liabilities BOY | 372557 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 745197 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 0 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE CARE WITH PASSION, COMPASSION, AND DIGNITY FOR THE ELDERLY AND THEIR FAMILIES OF OUR COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 4965711 | Expense |
| Grants | 807024 | Grants |
| Revenue | 4974567 | Revenue |
| Description | EDGERTON CARE CENTER, INC. (THE CARE CENTER) IS LICENSED BY THE WISCONSIN DEPARTMENT OF HEALTH TO OPERATE A 61-BED SKILLED NURSING CARE FACILITY THAT COMMENCED OPERATIONS ON JANUARY 1, 2007. AS PART OF THE CARE PRIVDED, THE CARE CENTER PROVIDES PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, SOCIAL ACTIVITIES, AND SOCIAL SERVICES.THE CARE CENTER HAS A QUALIFIED RECREATIONAL SPECIALIST THAT COORDINATES DIVERSE PROGRAMMING FOR RESIDENTS TO MEET THEIR VARIOUS NEEDS. THESE ACTIVITIES INCLUDE MUSIC, LARGE PARTIES TO INTERACT WITH PEERS, FAMILY EVENTS, AND THE OPPORTUNITY FOR CHILDREN OF VARIOUS AGES TO VISIT THE RESIDENTS. THE RESIDENTS ARE ALSO PROVIDED WITH THE OPPORTUNITY FOR MONTHLY TRIPS INTO THE COMMUNITY, ORGANIZED RELIGIOUS SERVICES ARE CONDUCTED BY RELIGIOUS LEADERS IN THE COMMUNITY ON A WEEKLY BASIS.THE CARE CENTER PROVIDES SERVICES TO RESIDENTS REGARDLESS OF PAYMENT SOURCE. THE CARE CENTER SOCIAL SERVICES AND ADMINISTRATIVE STAFF WORK PERSONALLY WITH EACH RESIDENT AND FAMILY TO DEETERMINE THEIR INDIVIDUAL FUNDING RESOURCES AVAILABLE AND TO SEARCH FOR OPTIONS IF RESOURCES SUCH AS INSURANCE OR MEDICARE ARE NOT AVAILABLE. THE CARE CENTER ALSO HAS RELATIONSHIPS WITH REGIONAL AND COUNTY SOCIAL WORKERS TO ASSIST IN THE APPLICATION PROCESS FOR MEDICAL ASSISTANCE. THIS IS AN ONGOING PROCESS FOR THOSE WITH INSURANCE, PRIVATE FUNDS, OR MEDICARE AS THOSE RESOURCES MAY BE EXHAUSTED. | Description |
| Total Program Service Expense | 4965711 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 1 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 5 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 147 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CINDY DEMOYE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3039800611 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13185 W GREEN MOUNTAIN DRIVE | AddressLine1 |
| City | LAKEWOOD | City |
| State | CO | State |
| ZIP Code | 80228 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (7 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| CHARLES NASON | ||||||
| CHAIRMAN OF THE BOARD | 1.00 | X | X | 0 | 0 | 0 |
| ANDY KERWIN | ||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 |
| NICHOLAS LYNN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| MARIAM GEHLER | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JILL KRUEGER | ||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 |
| KEN DEVITO | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| RAJEEV KUMAR | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| GENESIS REHAB SERVICES | |||||
| PO BOX 7247-6524 | PHILADELPHIA | PA | 191706524 | THERAPY SERVICES | 582707 |
| WISCONSIN ILLINOIS SENIOR HOUSING INC | |||||
| 13185 W GREEN MTN DRIVE | LAKEWOOD | CO | 80228 | MANAGEMENT SERVICES | 263211 |
| COMMUNITY LIVING SOLUTIONS | |||||
| PO BOX 241 | NEENAH | WI | 549560241 | ARCHITECTURE | 187196 |
| CARRIAGE HEALTHCARE INC | |||||
| 13185 W GREEN MTN DRIVE | LAKEWOOD | CO | 80228 | MANAGEMENT COMPANY | 164238 |
| SYSCO | |||||
| PO BOX 90 | BARABOO | WI | 539139990 | FOOD SERVICES | 141192 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Government Grants | 148500 | GovernmentGrants |
| All Other Contributions | 73503 | AllOtherContributions |
| Total Contributions | 222003 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| RESIDENT CARE REVENUE | 623000 | 3689827 | 3689827 |
| ANCILLIARY REVENUE | 623000 | 1247339 | 1247339 |
| MISC PATIENT BENEFIT R | 623000 | 37401 | 37401 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 4974567 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1348 | TotalRevenueColumn |
| Exclusion | $1,348 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5197918 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4974567 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,348 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 807024 | Total |
| Program Services | 807024 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2366211 | Total |
| Program Services | 2186764 | ProgramServices |
| Management And General | 179447 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 84520 | Total |
| Program Services | 76335 | ProgramServices |
| Management And General | 8185 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 170257 | Total |
| Program Services | 156483 | ProgramServices |
| Management And General | 13774 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 190830 | Total |
| Program Services | 153330 | ProgramServices |
| Management And General | 37500 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15046 | Total |
| Management And General | 15046 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45455 | Total |
| Management And General | 45455 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 79 | Total |
| Management And General | 79 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7601 | Total |
| Management And General | 7601 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13519 | Total |
| Management And General | 13519 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 656331 | Total |
| Program Services | 221854 | ProgramServices |
| Management And General | 434477 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11372 | Total |
| Program Services | 652 | ProgramServices |
| Management And General | 10720 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4382 | Total |
| Program Services | 4382 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59297 | Total |
| Program Services | 59297 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PURCHASED SERVICES AND | 783998 | 774536 | 9462 |
| SUPPLIES | 457533 | 453414 | 4119 |
| BUSINESS TAXES | 124440 | 124440 | |
| BAD DEBT EXPENSE | 15396 | 15396 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129824 | Total |
| Program Services | 71640 | ProgramServices |
| Management And General | 58184 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5943115 | Total |
| Program Services | 4965711 | ProgramServices |
| Management And General | 977404 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | X | InfoInScheduleOPartX |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 630426 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 477134 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10194 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1117754 | BOY |
| EOY | 0 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 361487 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11070 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 372557 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 728387 | BOY |
| EOY | 0 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16810 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 745197 | BOY |
| EOY | 0 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1117754 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -745197 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 55825 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 17994 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 5490 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 44175 | CurrentTaxYearMinus1Year |
| Current Tax Year | 222003 | CurrentTaxYear |
| Total | 345487 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 4478788 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 4539851 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3912583 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 4068320 | CurrentTaxYearMinus1Year |
| Current Tax Year | 4921770 | CurrentTaxYear |
| Total | 21921312 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 4534613 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 4557845 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3918073 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 4112495 | CurrentTaxYearMinus1Year |
| Current Tax Year | 5143773 | CurrentTaxYear |
| Total | 22266799 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 22266799 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | 1348 | CurrentTaxYear |
| Total | 1348 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | 1348 | CurrentTaxYear |
| Total | 1348 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 4534613 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 4557845 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3918073 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 4112495 | CurrentTaxYearMinus1Year |
| Current Tax Year | 5145121 | CurrentTaxYear |
| Total | 22268147 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99990 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 1.00000 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00010 | InvestmentIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 5182400 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -15518 | OtherRevenues |
| Revenue Not Rptd F990 | -15518 | RevenueNotRptdF990 |
| Revenue Subtotal | 5197918 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 5197918 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 5120600 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 5120600 | ExpensesSubtotal |
| Other Expenses Not Included | 822515 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 822515 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 5943115 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | FOOTNOTE 1 TO THE FINANCIAL STATEMENTS STATES MANAGEMENT HAS REVIEWED ITS OPERATIONS FOR UNCERTAIN TAX POSITIONS AND HAS DETERMINED NO UNCERTAIN TAX POSITIONS EXIST. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR ALLOWANCE FOR BAD DEBTS -15,396. ROUNDING -122. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR ALLOWANCE FOR BAD DEBTS 15,396. ROUNDING 95. CONTRIBUTION EXPENSE TO WISCONSIN ILLINOIS SENIOR HOUSING, INC. 807,024. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN ILLINOIS SENIOR HOUSING INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13185 W GREEN MOUNTAIN DRIVE | AddressLine1 |
| City | LAKEWOOD | City |
| State | CO | State |
| ZIP Code | 80228 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 364016275 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 807024 | AmountOfCashGrant |
| Purpose Of Grant | EDGERTON CARE CENTER, INC. CONTRIBUTED ITS NET ASSETS AS OF DECEMBER 31, 2012 TO WISCONSIN ILLINOIS SENIOR HOUSING (WISH). | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Schedule N IRS990ScheduleN
Disposition Table DispositionTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Asset | THE NET ASSETS OF EDGERTON CARE CENTER, INC (ECC) WERE CONTRIBUTED TO WISCONSIN ILLINOIS SENIOR HOUSING, INC (WISH), AS ECC WOULD BE OPERATING UNDER WISH EFFECTIVE 1/1/13. | DescriptionOfAsset |
| Date Of Distribution | 2012-12-31 | DateOfDistribution |
| FMV Of Asset | 807024 | FMVOfAsset |
| Method Of FMV Determination | THE DISTRIBUTION WAS BASED ON THE EDGERTON CARE CENER, INC. ENDING NET ASSET VALUE AS OF 12/31/12. | MethodOfFMVDetermination |
| EIN | 364016275 | EIN |
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN ILLINOIS SENIOR HOUSING INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13185 W GREEN MOUNTAIN DRIVE | AddressLine1 |
| City | LAKEWOOD | City |
| State | CO | State |
| ZIP Code | 80228 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501(C)(3) | IRCSection |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | 1 | DirectorOfSuccessor2 |
| Employee Of Successor2 | 0 | EmployeeOfSuccessor2 |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2 |
| Receive Compensation2 | 0 | ReceiveCompensation2 |
Form990 Schedule N Part III Form990ScheduleNPartIII (2 entries)
| ExplanationExplanation |
|---|
| PART II, LINE 2E: CHARLES NASON, ANDY KERWIN, NICHOLAS LYNN, MARIAM GEHLER, JILL KRUEGER, KEN DEVITO, RAJEEV KUMAR |
| PART II, LINE 2E: THESE TRUSTEES OF EDERATON CARE CENTER, INC. ARE BOARD MEMBERS OF WISCONSIN ILLINOIS SENIOR HOUSING, INC., THE SUCCESSOR ORGANIZATION. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION HAS ENGAGED CARRIAGE HEALTHCARE, INC. (CHC) TO PROVIDE MANAGEMENT SERVICES. CHC IS AN INDEPENDENT "FOR-PROFIT" ORGANIZATION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE BOARD HAS DESIGNATED THE CHAIRMAN AND SECRETARY TO REVIEW AND SIGN THE 990 ON BEHALF OF THE BOARD BEFORE IT IS FILED WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICTS ARE REVIEWED ON AN ANNUAL BASIS. EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE MUST SIGN A DISCLOSURE ANNUALLY. BOARD MEMBERS ARE EXPECTED TO DISCLOSE CONFLICTS AS THEY BECOME RELEVANT AT BOARD MEETINGS AND REFRAIN FROM VOTING ON MATTERS IN WHICH THEY HAVE A CONFLICT. | |
| FORM 990, PART VI, SECTION B, LINE 15A | COMPENSATION AND MANGEMENT COMPANY AGREEMENTS ARE REVIEWED BY INDEPENDENT BOARD MEMBERS ON AN ANNUAL BASIS. COMPARABLE DATA IS OBTAINED IN ORDER TO ESTABLISH REASONABLE AMOUNTS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, POLICIES AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. | |
| FORM 990 - PART X, LINE 16 AND 26 | EFFECTIVE DECEMBER 31, 2012 AT 12:00 A.M., EDGERTON CARE CENTER, INC. CONTRIBUTED ALL ITS ASSETS AND LIABILITIES TO WISH. THE BALANCE SHEET IN THIS RETURN REFLECTS THIS TRANSFER OF BALANCES ACCORDINGLY. | CONTRIBUTION OF EDGERTON CARE CENTER, INC. ASSETS AND LIABILITIES: |
| FORM 990 - LINE 2C SCHEDULE XI | THE ENTIRE BOARD REVIEWS AND HAS RESPONSIBILITY FOR THE FINANCIAL STATEMENTS. THIS POLICY IS UNCHANGED FROM PRIOR YEARS. | BOARD RESPONSIBILITY |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN ILLINOIS SENIOR HOUSING INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13185 W GREEN MOUNTAIN DRIVE | AddressLine1 |
| City | LAKEWOOD | City |
| State | CO | State |
| ZIP Code | 80228 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 364016275 | EIN |
| Primary Activities | LONG-TERM CARE FACILITIES | PrimaryActivities |
| Legal Domicile State | IL | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 9 | PublicCharityStatus |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| WISCONSIN ILLINOIS SENIOR HOUSING INC | ||
| B | 807024 | FAIR MARKET VALUE |
| WISCONSIN ILLINOIS SENIOR HOUSING INC | ||
| K | 402000 | LEASE AGREEMENT |