2025-10-31T16:54:30-05:00 2024-12-31 410746749 CLIFTONLARSONALLEN LLP 10401 W INNOVATION DR STE 300 WAUWATOSA WI 53226 990 2024-01-01 043794775 SHARON S RICHARDSON COMMUNITY HOSPICE INC SHAR 9204671800 W2850 STATE RD 28 SHEBOYGAN FALLS WI 53085 ERIC TETZLAFF CHIEF EXECUTIVE OFFICER 9204671800 2025-10-31 1 1 KRISTEN DONLEVY P01670215 4144761880 2025-10-28 2024 2025-03-06 01:10:19Z ERIC TETZLAFF W2850 STATE RD 28 SHEBOYGAN FALLS WI 53085 14988843 0 X WWW.SSRHOSPICEHOME.ORG X 2004 WI TO PROVIDE A FULL RANGE OF INNOVATIVE HOSPICE, BEREAVEMENT, PALLIATIVE CARE, AND OTHER SUPPORT AND IMPROVE THE QUALITY OF LIFE FOR A PATIENT WITH A LIFE-LIMITING ILLNESS AND THEIR CAREGIVERS IN THE SETTING OF THEIR CHOICE. 8 8 119 187 0 0 858723 1230210 13429095 13535961 38004 199122 -109460 -27200 14216362 14938093 0 0 0 0 10742988 10399585 0 0 502222 4095516 4064907 14838504 14464492 -622142 473601 14837716 15956062 4122430 4047567 10715286 11908495 X TO PROVIDE A FULL RANGE OF INNOVATIVE HOSPICE, BEREAVEMENT, PALLIATIVE CARE, AND OTHER SUPPORT DIGNITY, IDENTIFY CHOICES, AND IMPROVE THE QUALITY OF LIFE FOR A PATIENT WITH A LIFE-LIMITING ILLNESS AND THEIR CAREGIVERS IN THE SETTING OF THEIR CHOICE; ADDING VALUE TO OUR COMMUNITY AND NETWORK OF SERVICE PROVIDERS. OUR PROMISE IS TO PROVIDE COMPASSIONATE CARE AND QUALITY OF LIFE TO ALL THOSE IN NEED. 0 0 11194083 13535961 THE CORPORATION PROVIDES MEDICALLY NECESSARY SERVICES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS HOSPICE AND PALLIATIVE CARE ADMISSION CRITERIA. THE CORPORATION ALSO OFFERS SUPPORT TO ITS PATIENTS AND THEIR FAMILY WITH ANY EMOTIONAL, SOCIAL, AND SPIRITUAL NEEDS THEY MAY HAVE. SERVICES ARE PROVIDED TO PATIENTS LIVING IN THE HOSPICE CENTER, INDIVIDUAL RESIDENCES, NURSING HOMES, AND ASSISTED LIVING FACILITIES. 11194083 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 2 0 1 119 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X MARILYN MASI 9204671800 W2850 STATE RD 28 SHEBOYGAN FALLS WI 53085 JOSEPH VOELKNER BOARD MEMBER 2.00 X 0 0 0 STEVE MEYER BOARD CHAIR 2.00 X X 0 0 0 BARBARA GANNON BOARD MEMBER 2.00 X 0 0 0 DR CHANDA KAPUR BOARD MEMBER 2.00 X 0 0 0 DR JAMES KUPLIC BOARD MEMBER 2.00 X 0 0 0 JOE RICHARDSON III VICE CHAIR 2.00 X X 0 0 0 JUSTIN RICHARDSON DEVELOPMENT CHAIR 2.00 X X 0 0 0 SCOTT PAXTON DO MEDICAL DIRECTOR 40.00 X 281074 0 25435 LOU ANN MEYER BOARD MEMBER 2.00 X 0 0 0 ERIC TETZLAFF CHIEF EXECUTIVE DIRECTOR 40.00 X 195000 0 7851 CHARMAINE CONRAD CHIEF GROWTH, STRATEGY & D 40.00 X 141280 0 24570 MAUREEN LEAHY CHIEF CLINICAL OFFICER 40.00 X 155268 0 18206 MARILYN MASI SR. DIRECTOR FINANCIAL SUS 40.00 X 136738 0 22672 SHANA HOGUE NURSE PRACTITIONER 32.00 X 134414 0 7973 TRACY CINEALIS REFERRAL SPECIALIST 40.00 X 132808 0 7602 DAWN THAVES COMMUNITY OUTREACH SPECIALIST 40.00 X 121728 0 5314 1298310 0 119623 8 0 1 0 0 92830 1137380 1230210 PATIENT SERVICES 623000 12968980 12968980 THRIFT STORE REVENUE 623000 566981 566981 13535961 199122 199122 18600 92830 50750 -32150 -32150 MISCELLANEOUS INCOME 900099 4950 4950 4950 14938093 13535961 0 171922 991960 565417 396784 29759 7237696 6125682 832691 279323 167083 145183 15337 6563 1450078 1139280 256844 53954 552768 454278 77583 20907 8700 8700 74368 74368 30949 30949 153248 11131 100492 41625 417540 206265 173403 37872 11268 3162 908 7198 343540 309186 34354 553541 290101 253073 10367 106958 39369 67589 283062 108790 173308 964 64954 17201 47592 161 MEDICAL SUPPLIES AND PA 1734270 1734270 DUES & SUBSCRIPTIONS 63957 11099 43530 9328 OTHER SUPPLIES 17700 10698 2801 4201 200852 22971 177881 14464492 11194083 2768187 502222 2187982 3063155 7528 0 105669 155664 2059701 1563676 39516 61432 9734613 4716654 5249922 5017959 5016387 6037154 171011 57022 14837716 15956062 1050406 1126487 2897744 2860773 174280 60307 4122430 4047567 X 10552118 11515465 163168 393030 10715286 11908495 14837716 15956062 473601 719608 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4992950 220000 800767 6013717 4144562 120000 728388 4992950 4219992 620000 -695430 4144562 3316880 500000 403112 4219992 657728 2385972 273180 3316880 0.98350 0.01650 0 0 485418 485418 7059644 3196303 3863341 964916 553481 411435 1224635 966870 257765 5017959 INVESTMENTS 6013717 F INVESTMENT IN JOINT VENTURE 23437 F 6037154 OPERATING LEASES 4562 FINANCIAL LEASES 55745 60307 15658902 719608 32150 751758 14907144 30949 30949 14938093 14465693 32150 32150 14433543 30949 30949 14464492 PART V, LINE 4: INCOME FROM THE ENDOWMENT FUND WILL BE USED TO SUPPORT THE OPERATIONS OF THE ORGANIZATION. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 32,150. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 32,150. INPIRING THE CONVERSATION 111430 92830 18600 32500 18250 111430 92830 18600 32500 18250 50750 -32150 1 1 X 1 X 1 X 1 1 0 0 305000 0 305000 0.02110 85034 0 85034 0.00590 0 0 390034 390034 0.02700 0 0 0 0 0 0 0 0 0 0 390034 390034 0.02700 1 56340 3200 12305139 15456535 -3151396 X 0 1 2 SHARON S RICHARDSON COMMUNITY HOSPICE W2850 STATE RD 28 SHEBOYGAN FALLS WI 53085 WWW.SSRHOSPICEHOME.ORG 2019 X HOSPICE CENTER SHARON S RICHARDSON COMMUNITY HOSPICE 1 0 0 0 0 1 X 200.000000000000 200.000000000000 X X X X 1 1 X X X 1 X WWW.SSRHOSPICEHOME.ORG X X X X X 0 0 X X X 0 X X 0 1 SHARON S. RICHARDSON COMMUNITY HOSPICE PART V, SECTION B, LINE 24: ALL PATIENTS, WHETHER INSURED OR NOT, ARE CHARGED THE SAME AMOUNT. PART I, LINE 3C: INCOME LEVEL OTHER THAN FPG, ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS PART II, COMMUNITY BUILDING ACTIVITIES: NOT APPLICABLE PART III, LINE 2: THE ORGANIZATION SENDS A TOTAL OF THREE PATIENT STATEMENTS, IF NO RESPONSE OR PAYMENT, THE ACCOUNT IS ADJUSTED AS BAD DEBT. PART III, LINE 3: SEVERAL PATIENTS DID NOT RETURN THEIR FINANCIAL HARDSHIP FORMS, AS REQUIRED BY OUR POLICY, THOSE WERE ADJUSTED AS BAD DEBT. PART III, LINE 4: THE ORGANIZATION PROVIDES FOR ESTIMATED UNCOLLECTIBLE AMOUNTS THROUGH A CHARGE TO EARNINGS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON MANAGEMENT'S ASSESSMENT OF THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS, GIVING CONSIDERATION TO HISTORICAL EXPERIENCE AND EXISTING ECONOMIC CONDITIONS. PART III, LINE 8: PROVIDER STATISTICAL & REIMBURSEMENT SYSTEM.THE SHORTFALL SHOULD NOT BE TREATED AS A COMMUNITY BENEFIT, BUT IS PURELY A COST OF DOING BUSINESS AND IS DIRECTLY RELATED TO OPERATING EXPENSES IN EXCESS OF REVENUES. PART III, LINE 9B: THE ORGANIZATION DOES NOT HAVE A WRITTEN DEBT COLLECTION POLICY BECAUSE THEY DO NOT SEND ANY PATIENT OR FAMILY TO COLLECTIONS. THE ORGANIZATION SENDS THREE STATEMENTS TO THE FAMILY AND/OR PATIENT PRIOR TO ADJUSTING THE BALANCE TO UNCOLLECTIBLE. PART VI, LINE 2: THE ORGANIZATION DETERMINES THE NEEDS OF TERMINALLY ILL INDIVIDUALS ON A CASE BY CASE SITUATION. PART VI, LINE 3: THE PROCESS IS EXPLAINED TO THE PATIENTS AND THEIR FAMILIES PRIOR TO ADMITTANCE AND IS MENTIONED IN MONTHLY NEWSLETTERS. PART VI, LINE 4: THE ORGANIZATION PROVIDES HOSPICE AND PALLIATIVE CARE TO A FIVE COUNTY AREA. WITHIN THIS AREA IS A WIDE DIVERSITY OF DEMOGRAPHICS THE ORGANIZATION CATERS TO. PART VI, LINE 5: THE ORGANIZATION PROVIDES SERVICES REGARDLESS OF ABILITY TO PAY. IN ADDITION, THIS IS THE ONLY FREE STANDING HOSPICE IN THE LAKESHORE REGION. PART VI, LINE 6: THIS ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES WI X X 0 0 0 0 0 0 0 0 0 SCOTT PAXTON DO MEDICAL DIRECTOR 281074 0 0 0 0 0 9942 0 15493 0 306509 0 0 0 ERIC TETZLAFF CHIEF EXECUTIVE DIRECTOR 195000 0 0 0 0 0 6563 0 1288 0 202851 0 0 0 MAUREEN LEAHY CHIEF CLINICAL OFFICER 147582 0 7686 0 0 0 5146 0 13060 0 173474 0 0 0 CHARMAINE CONRAD CHIEF GROWTH, STRATEGY & D 141280 0 0 0 0 0 4881 0 19689 0 165850 0 0 0 MARILYN MASI SR. DIRECTOR FINANCIAL SUS 136738 0 0 0 0 0 4719 0 17953 0 159410 0 0 0 PART I, LINE 3 SALARY SURVEYS AND STUDIES ARE PERFORMED USING PAYSCALE, ADP, ETC. A TOWN OF LIMA WISCONSIN 391603552 532598AB5 2009-12-01 5460000 FINANCE CONSTRUCTION OF THE CENTER 0 0 0 A 2520000 5460000 79647 5380353 2007 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 1 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 2 JOE RICHARDSON III IS THE FATHER OF JUSTIN RICHARDSON. ONE OF OUR DIRECTORS OPERATES A BUSINESS WHICH SERVICES SOME OF THE OTHER DIRECTORS BUSINESSES. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD WILL REVIEW THE 990 PRIOR TO FILING FOR FEDERAL PURPOSES. THE FIRST WEEK IT IS AVAILABLE IT WILL BE DISTRIBUTED TO BOARD MEMBERS WHO WILL THEN REVIEW IT ON THEIR OWN AND RESPOND WITH ANY QUESTIONS, IF THEY HAVE ANY. ERIC TETZLAFF, CEO, WILL PERFORM A MORE EXTENSIVE REVIEW AND TRACE 990 NUMBERS TO THE FINANCIAL STATEMENTS. FORM 990, PART VI, SECTION B, LINE 12C BY REVIEWING THE FORMS AND HAVING CONVERSATIONS WITH THOSE AFFECTED REGARDING THE CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE EVALUATION AND COMPENSATION OF THE TOP MANAGEMENT OFFICIAL ARE CONSIDERED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS; THE CFO PROVIDES ASSISTANCE AND DOCUMENTATION FOR THE PROCESS. COMPENSATION IS RECOMMENDED BY THE EXECUTIVE COMMITTEE AND APPROVED BY THE BOARD, THIS IS DONE ANNUALLY. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2024. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST RICHARDSON HOSPICE RESALE STORE 1130 PLANKVIEW GREEN BLVD SHEBOYGAN FALLS WI 53085 463062674 THRIFT STORE WI 566981 154854 SHARON S RICHARDSON COMMUNITY HOSPICE INC