2024-09-10T11:02:51-05:00 2023-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-01-01 873555983 EVERGREEN SENIOR LIVING INC EVER 7153869303 1320 WISCONSIN STREET HUDSON WI 54016 PAMELA KLINGFUS CHIEF EXECUTIVE OFFICER 7153869303 2024-09-10 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2024-09-10 2023 2024-08-08 14:25:15Z PAMELA KLINGFUS 1320 WISCONSIN STREET HUDSON WI 54016 819734 0 X WWW.CCHHUDSON.ORG X 2021 WI NONPROFIT ORGANIZATION SERVING SENIORS IN WAYS THAT REFLECT THE IMPORTANCE OF EACH UNIQUE LIFE. 14 14 0 0 0 0 0 0 838624 819386 73 348 0 0 838697 819734 0 0 0 0 338904 433477 0 0 0 558811 527145 897715 960622 -59018 -140888 2684204 2592412 2744578 2793674 -60374 -201262 WE ARE A NONPROFIT, FAITH-BASED ORGANIZATION OFFERING SENIOR LIVING COMMUNITIES DEDICATED TO SERVING INDIVIDUALS IN WAYS THAT REFLECT THE IMPORTANCE OF EACH UNIQUE LIFE. 0 0 853713 0 819386 EVERGREEN PROVIDES SENIORS AND HANDICAPPED PERSONS WITH HOUSING AND SERVICES AVAILABLE TO MEET THEIR NEEDS. AMONG THE MANY SERVICES PROVIDED ARE 24-HOUR ON-SITE STAFF, ASSISTANCE WITH MEDICATIONS AND VITAL CHECKS, QUARTERLY AND ANNUAL NURSING ASSESSMENTS, TRANSPORTATION SERVICES, AND ASSISTANCE WITH DAILY CARES. TOTAL RENTAL DAYS AT EVERGREEN APARTMENTS FOR 2023 WERE 9,900.EVERGREEN PROP CO. IS THE REAL ESTATE HOLDING COMPANY FOR EVERGREEN APARTMENTS. 853713 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X JAMES KACZROWSKI 7153869303 1320 WISCONSIN STREET HUDSON WI 54016 DARYL SIMONSON PRESIDENT 1.00 2.00 X X 0 0 0 CLAIRE ZAJAC VICE PRESIDENT 1.00 2.00 X X 0 0 0 ERIC JOHNSON TREASURER 1.00 2.00 X X 0 0 0 DEB SCHWAB SECRETARY 1.00 2.00 X X 0 0 0 ELLIOT ANDERSON MEMBER 1.00 2.00 X 0 0 0 MIKE BEBAULT MEMBER 1.00 2.00 X 0 0 0 RHONDA DUNHAM MEMBER 1.00 2.00 X 0 0 0 FR JOHN GERRITS MEMBER 1.00 2.00 X 0 0 0 CRAIG GIBSON MEMBER 1.00 2.00 X 0 0 0 RICK HAGAR MEMBER (TERMED MAY) 1.00 2.00 X 0 0 0 MEL HERMANSEN MEMBER 1.00 2.00 X 0 0 0 RUTH KNAPP MEMBER (TERMED MAY) 1.00 2.00 X 0 0 0 AARON MORK MEMBER 1.00 2.00 X 0 0 0 TOM NIELSEN MEMBER (TERMED MAY) 1.00 2.00 X 0 0 0 REV DR DAWN JEFFERS RAMSTAD MEMBER 1.00 2.00 X 0 0 0 TOM REDDING MEMBER (TERMED MAY) 1.00 2.00 X 0 0 0 BOB STAEBELL MEMBER 1.00 2.00 X 0 0 0 REV JACK STARR MEMBER 1.00 2.00 X 0 0 0 PAMELA KLINGFUS CEO 1.00 39.00 X 0 198482 12115 JIM KACZROWSKI DIRECTOR OF FINANCE 1.00 39.00 X 0 130579 16048 0 329061 28163 0 0 1 0 0 NURSING HOME 623000 722438 722438 ASSISTED LIVING 623990 92561 92561 4387 4387 819386 348 348 819734 819386 0 348 388516 324193 64323 16385 16385 28576 28576 8560 8560 25862 24115 1747 4784 4784 21744 21744 3579 3579 47120 47120 662 662 105149 105149 156555 156555 20968 20968 REPAIRS AND MAINTENANCE 59178 58030 1148 DIETARY SUPPLIES 41768 41768 BAD DEBT EXPENSE 20250 20250 MEDICAL SUPPLIES 5491 5491 5475 5113 362 960622 853713 106909 0 29033 44192 13194 15424 2765638 288842 2578977 2476796 63000 56000 2684204 2592412 11555 13159 28790 37342 2042470 1982588 661763 760585 2744578 2793674 X -60374 -201262 -60374 -201262 2684204 2592412 -140888 0 X 0 1 X 1 0 X 838624 819386 1658010 838624 819386 1658010 0 0 0 1658010 73 348 421 73 348 421 838697 819734 1658431 X 0 1 X 79500 79500 2598069 262306 2335763 88069 26536 61533 2476796 RELATED PARTY LIABILITY 760585 760585 PART IV, LINE 2B: FOR A RESIDENT TO RESERVE AN APARTMENT, THEY AGREE TO TRANSFER TO EVERGREEN A REFUNDABLE TENANT SECURITY DEPOSIT. UPON VACATING AN APARTMENT, THIS DEPOSIT IS REFUNDED TO THE RESIDENT THE FIRST OF THE MONTH AFTER THE APARTMENT HAS BEEN RERENTED OR AFTER SIX MONTHS AFTER VACATING IT, WHICHEVER COMES FIRST. RESIDENT TRUST FUNDS CONSIST OF AMOUNTS ON DEPOSIT WITH THE CORPORATION BY RESIDENTS FOR SAFEKEEPING. THESE FUNDS CAN BE WITHDRAWN AT ANY TIME BY THE RESIDENTS. 0 0 0 0 0 0 0 0 0 PAMELA KLINGFUS CEO 0 195982 0 2500 0 0 0 11920 0 195 0 210597 0 0 SCHEDULE J, PART I, LINE 3: A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -INDEPENDENT COMPENSATION CONSULTANT -WRITTEN EMPLOYMENT CONTRACT -COMPENSATION SURVEY OR STUDY, AND -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS SHALL BE COMPOSED OF INDIVIDUALS AT LEAST 51% OF WHOM ARE AFFILIATED WITH THE UNITED METHODIST CHURCH OF HUDSON. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE RETURN IS MADE AVAILABLE TO THE BOARD OF DIRECTORS PRIOR TO FILING FOR THEIR REVIEW AND COMMENTS. THE DIRECTOR OF FINANCE AND CHIEF EXECUTIVE OFFICER OF CHRISTIAN COMMUNITY HOMES AND SERVICES, INC. REVIEWS AND APPROVES THE FORM 990 PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE EXECUTIVE DIRECTOR AND DIRECTOR OF MISSION ADVANCEMENT MONITOR THE CONFLICT OF INTEREST POLICY FOR COMPLIANCE ON AN ON-GOING BASIS TO ENSURE THAT MEMBERS OF THE BOARD OF DIRECTORS HAVE IDENTIFIED AND DISCLOSED ALL POTENTIAL CONFLICTS THAT COULD INFLUENCE THEIR DECISION MAKING IN THEIR ROLES AS BOARD MEMBERS. EXAMPLES INCLUDED IN THE POLICY INCLUDE BOARD MEMBERS WHO HAVE BUSINESS DEALINGS WITH THE ORGANIZATION OR WHO HAVE RELATIVES WHO ARE RESIDENTS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 CHRISTIAN COMMUNITY HOMES AND SERVICES, INC.'S EXECUTIVE COMMITTEE APPROVES THE COMPENSATION AGREEMENT WITH THE EXECUTIVE DIRECTOR ON AN ANNUAL BASIS, AFTER OBTAINING AND CONSIDERING COMPARABILITY DATA. THE BASIS FOR THE COMPENSATION DETERMINATION IS ADEQUATELY DOCUMENTED IN THE MINUTES OF THE MEETING FOR WHICH THE DETERMINATION WAS MADE. ON AN ANNUAL BASIS, THE BOARD APPROVES THE SALARY INCREASE BUDGET FOR ALL EMPLOYEES. AS ANNUAL PERFORMANCE REVIEWS ARE DUE (BASED ON ANNIVERSARY DATES), THE EXECUTIVE DIRECTOR WILL REVIEW THE LEADING AGE WAGE SURVEYS AND BRING FORTH THE RECOMMENDATION TO THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 CHRISTIAN COMMUNITY HOMES AND SERVICES MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST DURING NORMAL BUSINESS HOURS AT THE OFFICES OF CHRISTIAN COMMUNITY HOMES AND SERVICES. EVERGREEN APARTMENTS PROPCO LLC 1320 WISCONSIN STREET HUDSON WI 54016 873880271 REAL ESTATE HOLDING COMPANY WI -23658 117533 EVERGREEN SENIOR LIVING INC CHRISTIAN COMMUNITY HOMES AND SERVICES INC 1320 WISCONSIN ST HUDSON WI 54016 391801003 TO SERVE AS THE PARENT COMPANY FOR SEVERAL SENIOR CARE FACILITIES WI 501(C)(3) LINE 12C, III-FI N/A 0 CHRISTIAN COMMUNITY HOMES AND SERVICES INC GROUP RETURN 1320 WISCONSIN ST HUDSON WI 54016 912052713 SENIOR LIVING WI 501(C)(3) LINE 10 CHRISTIAN COMMUNITY HOMES AND SERVICES INC 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0