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BETHANY HOME INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
BETHANY HOME INC (EIN 39-0868849)
Tax period
2019-10-01 to 2020-09-30
Filed
2021-07-26
IRS object ID
202122079349301122
Schema version
2019v5.2
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

FieldValueIRS element (for citing)
Return2021-07-26T11:36:45-05:00ReturnTs
Tax Period End2020-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN390758449PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11502 LONDON ROAD SUITE 200AddressLine1Txt
CityDULUTHCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55812ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN390868849EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BETHANY HOME INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlBETHBusinessNameControlTxt
Phone7152585521PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11226 BERLIN STREETAddressLine1Txt
CityWAUPACACityNm
State AbbreviationWIStateAbbreviationCd
ZIP54981ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSHELLY SONTAGPersonNm
Person TitleCEOPersonTitleTxt
Phone7152585521PhoneNum
Signature2021-06-29SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMICHAEL J PETERSON CPAPreparerPersonNm
PTINP01833529PTIN
Phone2187224705PhoneNum
Preparation2021-06-29PreparationDt
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSHELLY SONTAGPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11226 BERLIN STREETAddressLine1Txt
CityWAUPACACityNm
State AbbreviationWIStateAbbreviationCd
ZIP54981ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$13,104,400GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.BETHANYOFWAUPACA.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1961FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionTO PROVIDE A CHRISTIAN HOME FOR AGED AND INFIRM MEN AND WOMEN WHO NEED THE SERVICES OF THE HOME.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee378TotalEmployeeCnt
Total Volunteers18TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$66,760PYContributionsGrantsAmt
CY Contributions Grants$586,439CYContributionsGrantsAmt
PY Program Service Revenue$11,375,376PYProgramServiceRevenueAmt
CY Program Service Revenue$12,487,742CYProgramServiceRevenueAmt
PY Investment Income-$2,259PYInvestmentIncomeAmt
CY Investment Income$6,454CYInvestmentIncomeAmt
PY Other Revenue$43,403PYOtherRevenueAmt
CY Other Revenue$23,765CYOtherRevenueAmt
PY Total Revenue$11,483,280PYTotalRevenueAmt
CY Total Revenue$13,104,400CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$7,193,722PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$6,870,154CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$5,757,929PYOtherExpensesAmt
CY Other Expenses$5,988,481CYOtherExpensesAmt
PY Total Expenses$12,951,651PYTotalExpensesAmt
CY Total Expenses$12,858,635CYTotalExpensesAmt
PY Revenues Less Expenses-$1,468,371PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$245,765CYRevenuesLessExpensesAmt
Total Assets BOY$26,530,764TotalAssetsBOYAmt
Total Assets EOY$26,868,701TotalAssetsEOYAmt
Total Liabilities BOY$27,170,364TotalLiabilitiesBOYAmt
Total Liabilities EOY$27,249,763TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$639,600NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$381,062NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionBETHANY HOME IS ORGANIZED TO PROVIDE A CHRISTIAN HOME FOR AGED AND INFIRM MEN AND WOMEN WHO NEED THE SERVICES OF THE HOME.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$8,505,127ExpenseAmt
Grant$0GrantAmt
Revenue$8,874,725RevenueAmt
DescNURSING HOME:BETHANY HOME, INC. OPERATES A 100 BED NURSING HOME TO PROVIDE LONG-TERM CARE SERVICES TO RESIDENTS OF WAUPACA COUNTY AND THE IMMEDIATE SURROUNDING AREA. BETHANY HOME, INC. MEMBERSHIP CONSISTS OF 32 CHURCH CONGREGATIONS FROM WAUPACA, THE SURROUNDING RURAL AREAS, AND SEVERAL NEIGHBORING COMMUNITIES. DURING OUR FISCAL YEAR ENDED SEPTEMBER 30, 2020, WE PROVIDED 26,550 INPATIENT DAYS OF SERVICE. OF THESE DAYS, 15,128 DAYS, ABOUT 57% OF OUR CARE, WERE PROVIDED TO MEN AND WOMEN WHO NO LONGER HAD ADEQUATE FUNDS TO PAY FOR THEIR CARE. THEIR CARE WAS PAID FOR BY THE WISCONSIN MEDICAL ASSISTANCE PROGRAM AT RATES THAT WERE BELOW OUR COST OF PROVIDING THAT CARE. WE ALSO PROVIDED 4,574 DAYS OF CARE TO RESIDENTS WHO WERE FUNDED BY THE FEDERAL MEDICARE ADVANTAGE PROGRAMS. THESE DAYS EQUALED 17% OF THE CARE WE PROVIDED. THE REMAINING 6,924 DAYS OF CARE, REPRESENTING 26% OF OUR BUSINESS, WERE PROVIDED TO RESIDENTS WHO PAID FROM THEIR PERSONAL PRIVATE FUNDS.THE SERVICES THAT BETHANY HOME PROVIDES TO ITS RESIDENTS INCLUDE: *24 HOUR PER DAY NURSING CARE DELIVERED BY OUR STAFF OF REGISTERED NURSES *LICENSED PRACTICAL NURSES *CERTIFIED NURSING ASSISTANTS *7 DAY PER WEEK REHABILITATION SERVICES PROVIDED BY REGISTERED PHYSICAL THERAPISTS *PHYSICAL THERAPY ASSISTANTS AND AIDES *REGISTERED OCCUPATIONAL THERAPISTS *CERTIFIED OCCUPATIONAL THERAPY ASSISTANTS *REGISTERED SPEECH THERAPISTS *DELICIOUS AND NUTRITIOUS MEALS *SOCIAL SERVICES *RECREATIONAL ACTIVITIES *HOUSEKEEPING AND LAUNDRY SERVICES, INCLUDING THE IRONING OF PERSONAL CLOTHING *BUILDING AND GROUNDS MAINTENANCE *TRANSPORTATION TO MEDICAL APPOINTMENTS *BEAUTY AND BARBER SHOP SERVICES *ADMINISTRATIVE SERVICESBETHANY COMMUNITY CARE MINISTRYBETHANY HOME PROVIDES NURSES FOR SERVICES IN THE COMMUNITY SUCH AS CLINICS AND SCREENINGS, EDUCATION TO OLDER AND DISABLED ADULTS AND CAREGIVERS, INFORMATION AND REFERRAL, SEMINARS, AND VOLUNTEER PROGRAM DEVELOPMENT TO SERVE OLDER ADULTS IN THEIR HOMES. THE PURPOSE OF THE PROGRAM IS TO HELP THOSE IN THE COMMUNITY REMAIN IN THEIR HOME FOR AS LONG AS THEY AND THEIR FAMILIES ARE ABLE.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$1,783,598ExpenseAmt
Grant$0GrantAmt
Revenue$1,861,106RevenueAmt
DescHEARTWOOD - COMMUNITY-BASED RESIDENTIAL FACILITY (CBRF): BETHANY HOME, INC. ALSO OPERATES HEARTWOOD, A 49 -BED BUILDING THAT PROVIDES SUPPORTIVE LIVING SERVICES AND ASSISTED LIVING TO RESIDENTS OF WAUPACA COUNTY AND THE IMMEDIATE SURROUNDING AREA. AS OF SEPTEMBER 30, 2020, BETHANY PINES HAD 42 ROOMS RENTED AS A REGISTERED COMMUNITY BASED RESIDENTIAL FACILITY. BETHANY PINES CBRF ACCEPTS RESIDENTS WHO PAY PRIVATELY AND THOSE WHO ARE ON A FAMILY CARE PLAN. AS OF SEPTEMBER 30, 2020, 74% OF THE RESIDENTS WERE IN THE COMMUNITY BASED RESIDENTIAL FACILITY UNDER THE FAMILY CARE PROGRAM.THE SERVICES PROVIDED BY HEARTWOOD CBRF MAKE IT POSSIBLE FOR ITS RESIDENTS TO REMAIN IN A HOMELIKE ATMOSPHERE FOR A LONGER PERIOD OF TIME AND DELAYS, AND IN MANY CASES ELIMINATES ENTIRELY, THEIR ENTRANCE INTO A NURSING HOME. THE SERVICES THAT HEARTWOOD CBRF PROVIDES TO OUR RESIDENTS INCLUDE:*TASTY AND NUTRITIOUS MEALS*HELP WITH LAUNDRY AND HOUSEKEEPING NEEDS*ASSISTANCE AS NEEDED WITH ACTIVITIES OF DAILY LIFE, INCLUDING BATHING, DRESSING, TOILETING, AMBULATING, AND TRANSFERRING*MEDICATION MONITORING AND DELIVERY*RECREATIONAL ACTIVITIES*SPIRITUAL COUNSELING*ACTIVITIES OF DAILY LIVING*MEDICATION PASS*CLINICAL ASSESSMENTS*MONITORING*TRANSFERRING IF/WHEN NECESSARY*SOCIAL WORK AND RN SERVICESTHE RESIDENTS OF HEARTWOOD CBRF ALSO RECEIVE PRIORITY ADMISSION TO BETHANY HOME IF THEIR HEALTH CONDITIONS CHANGE AND THEY REQUIRE SKILLED CARE NURSING SERVICES. THIS FEATURE OF OUR CONTINUUM OF CARE GIVES THE HEARTWOOD CBRF RESIDENTS A REAL SENSE OF SECURITY, BECAUSE THEY KNOW THAT WE WILL CONTINUE TO CARE FOR THEM, EVEN WHEN THEIR NEEDS BECOME GREATER. HEARTWOOD CBRF BUILDING IS CONNECTED TO BETHANY HOME BY AN ENCLOSED, HEATED, AIR-CONDITIONED WALKWAY. THIS FEATURE MAKES IT VERY EASY AND CONVENIENT FOR RESIDENTS OF HEARTWOOD CBRF TO FREQUENTLY VISIT THEIR SPOUSES AND/OR FRIENDS WHOM LIVE IN BETHANY HOME. THIS EASY ACCESS TO THEIR LOVED ONE IN THE NURSING HOME HAS HELPED MANY OF OUR HEARTWOOD CBRF RESIDENTS TO BETTER DEAL WITH THE GUILT THAT IS SO OFTEN ASSOCIATED WITH HAVING TO PLACE A SPOUSE OR OTHER LOVED ONE IN A NURSING HOME.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$1,678,951ExpenseAmt
Grant$0GrantAmt
Revenue$1,751,911RevenueAmt
DescBETHANY PINES APARTMENTS: BETHANY HOME, INC. ALSO OPERATES THE PINES, A 40-UNIT APARTMENT BUILDING THAT PROVIDES SUPPORTIVE LIVING SERVICES AND ASSISTED LIVING SERVICES TO RESIDENTS OF WAUPACA COUNTY AND THE IMMEDIATE SURROUNDING AREA. AS OF SEPTEMBER 30, 2020, THE PINES HAD 37 APARTMENTS RENTED AS A REGISTERED RESIDENTIAL CARE APARTMENT COMPLEX (RCAC). THE SERVICES PROVIDED BY THE PINES MAKE IT POSSIBLE FOR ITS RESIDENTS TO REMAIN IN A HOMELIKE ATMOSPHERE FOR A LONGER PERIOD OF TIME AND DELAYS, AND IN MANY CASES ELIMINATES ENTIRELY, THEIR ENTRANCE INTO A NURSING HOME. THE SERVICES THAT THE PINES PROVIDES TO OUR RESIDENTS INCLUDE:*TASTY AND NUTRITIOUS MEALS*HELP WITH LAUNDRY AND HOUSEKEEPING NEEDS*ASSISTANCE AS NEEDED WITH ACTIVITIES OF DAILY LIFE, INCLUDING BATHING, DRESSING, TOILETING, AMBULATING, AND TRANSFERRING*MEDICATION MONITORING AND DELIVERY*RECREATIONAL ACTIVITIES*SPIRITUAL COUNSELING*ACTIVITIES OF DAILY LIVING*MEDICATION PASS*CLINICAL ASSESSMENTS*MONITORING*TRANSFERRING IF/WHEN NECESSARY*SOCIAL WORK AND RN SERVICESTHE RESIDENTS OF THE PINES ALSO RECEIVE PRIORITY ADMISSION TO BETHANY HOME IF THEIR HEALTH CONDITIONS CHANGE AND THEY REQUIRE SKILLED CARE NURSING SERVICES. THIS FEATURE OF OUR CONTINUUM OF CARE GIVES THE THE PINES RESIDENTS A REAL SENSE OF SECURITY, BECAUSE THEY KNOW THAT WE WILL CONTINUE TO CARE FOR THEM, EVEN WHEN THEIR NEEDS BECOME GREATER. OUR THE PINES APARTMENT BUILDING IS CONNECTED TO BETHANY HOME BY AN ENCLOSED, HEATED, AIR-CONDITIONED WALKWAY. THIS FEATURE MAKES IT VERY EASY AND CONVENIENT FOR RESIDENTS OF THE PINES TO FREQUENTLY VISIT THEIR SPOUSES AND/OR FRIENDS WHOM LIVE IN BETHANY HOME. THIS EASY ACCESS TO THEIR LOVED ONE IN THE NURSING HOME HAS HELPED MANY OF OUR THE PINES RESIDENTS TO BETTER DEAL WITH THE GUILT THAT IS SO OFTEN ASSOCIATED WITH HAVING TO PLACE A SPOUSE OR OTHER LOVED ONE IN A NURSING HOME.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$11,967,676TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (1)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document10IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee378EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1KERRY LEE BLANKE FINANCE DIRECTORBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7159421412PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11226 BERLIN STREETAddressLine1Txt
CityWAUPACACityNm
State AbbreviationWIStateAbbreviationCd
ZIP54981ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
SHELLY SONTAG
ADMINISTRATOR/CEO35.005.00Yes (X)$89,619$0$6,342
KERRY LEE BLANKE
FINANCE DIRECTOR35.005.00Yes (X)$47,445$0$0
GLEN BULLICK
PRESIDENT0.400.10Yes (X)$0$0$0Yes (X)
PAUL ONAN
VICE PRESIDENT0.400.10Yes (X)$0$0$0Yes (X)
BIL SUTLIEF
SECRETARY/ TREASURER0.400.10Yes (X)$0$0$0Yes (X)
VICKI GROTH
DIRECTOR0.400.10$0$0$0Yes (X)
WAYNE LUCK
DIRECTOR0.400.10$0$0$0Yes (X)
ROBERT NYGAARD
DIRECTOR (THROUGH JUNE)0.400.10$0$0$0Yes (X)
JEFF OESTREICH
DIRECTOR0.400.10$0$0$0Yes (X)
WILSON ROANE
DIRECTOR0.400.10$0$0$0Yes (X)
ERIN TUBBS
DIRECTOR0.400.10$0$0$0Yes (X)
DALE WILSON
DIRECTOR0.400.10$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$137,064TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$6,342TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
GENESIS ELDERCARE REHABILITATION SERVICE
PO BOX 821322PHILADELPHIAPA19182THERAPY CONTRACTOR$676,274
WIPFLI LLP
11 SCOTT STREETSCOTT STREET WAUSAUWI54403ACCOUNTING SERVICES$106,846
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
Government Grants$567,185GovernmentGrantsAmt
All Other Contributions$19,254AllOtherContributionsAmt
Noncash Contributions$68,710NoncashContributionsAmt
Total Contributions$586,439TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
RESIDENT SERVICE REVENUE623000$8,398,447$8,398,447
BETHANY PINES RENTAL532000$3,613,017$3,613,017
BETHANY SHADOW WOODS SERVICE AGRE900099$105,600$105,600

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$370,678TotalRevenueColumnAmt
Related Or Exempt Func Income$370,678RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$12,487,742TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$611TotalRevenueColumnAmt
Exclusion$611ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$5,843OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$5,843OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$5,843TotalRevenueColumnAmt
Exclusion$5,843ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
BEAUTY SHOP900099$14,771$14,771
CAFETERIA722514$8,994$8,994
FieldValueIRS element (for citing)
Other Revenue Total$23,765OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$13,104,400TotalRevenueColumnAmt
Related Or Exempt Func Income$12,487,742RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$30,219ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$250,240TotalAmt
Program Services$227,344ProgramServicesAmt
Management And General$22,896ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$5,382,080TotalAmt
Program Services$4,889,639ProgramServicesAmt
Management And General$492,441ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$75,752TotalAmt
Program Services$67,393ProgramServicesAmt
Management And General$8,359ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$715,375TotalAmt
Program Services$636,323ProgramServicesAmt
Management And General$79,052ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$446,707TotalAmt
Program Services$397,569ProgramServicesAmt
Management And General$49,138ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$8,457TotalAmt
Management And General$8,457ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$51,130TotalAmt
Management And General$51,130ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$217,250TotalAmt
Program Services$217,250ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$57,689TotalAmt
Program Services$57,689ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$382,681TotalAmt
Program Services$382,681ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$44,081TotalAmt
Management And General$44,081ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$352,145TotalAmt
Program Services$352,145ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$23,626TotalAmt
Program Services$22,404ProgramServicesAmt
Management And General$1,222ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$11,356TotalAmt
Program Services$6,920ProgramServicesAmt
Management And General$4,436ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$630,795TotalAmt
Program Services$630,795ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,349,054TotalAmt
Program Services$1,281,601ProgramServicesAmt
Management And General$67,453ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$107,344TotalAmt
Program Services$107,344ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
PROGRAM SUPPLIES$1,055,810$1,055,810
THERAPIES$535,524$535,524
T19 ASSESSMENT$191,250$191,250
BAD DEBT EXPENSE$176,090$176,090

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$794,199TotalAmt
Program Services$731,905ProgramServicesAmt
Management And General$62,294ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$12,858,635TotalAmt
Program Services$11,967,676ProgramServicesAmt
Management And General$890,959ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$601,732BOYAmt
EOY$2,045,355EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$825,326BOYAmt
EOY$810,818EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$975,075BOYAmt
EOY$951,897EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$42,761BOYAmt
EOY$62,717EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$63,321BOYAmt
EOY$49,989EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$33,613,406LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$10,945,589LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$23,800,214BOYAmt
EOY$22,667,817EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$222,335BOYAmt
EOY$235,108EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$45,000EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$26,530,764BOYAmt
EOY$26,868,701EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,404,406BOYAmt
EOY$808,762EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$132,191EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$66,142BOYAmt
EOY$56,096EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$24,966,170BOYAmt
EOY$24,438,357EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$733,646BOYAmt
EOY$1,814,357EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$27,170,364BOYAmt
EOY$27,249,763EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$869,860BOYAmt
EOY-$569,261EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$230,260BOYAmt
EOY$188,199EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$639,600BOYAmt
EOY-$381,062EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$26,530,764BOYAmt
EOY$26,868,701EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$245,765ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$12,773NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$16,621CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$25,680CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$52,238CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$66,760CurrentTaxYearMinus1YearAmt
Current Tax Year$586,439CurrentTaxYearAmt
Total$747,738TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,635,630CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$9,628,513CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$10,197,576CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$11,375,376CurrentTaxYearMinus1YearAmt
Current Tax Year$12,487,742CurrentTaxYearAmt
Total$52,324,837TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$62,747CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$74,948CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$43,409CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$43,403CurrentTaxYearMinus1YearAmt
Current Tax Year$23,765CurrentTaxYearAmt
Total$248,272TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,714,998CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$9,729,141CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$10,293,223CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$11,485,539CurrentTaxYearMinus1YearAmt
Current Tax Year$13,097,946CurrentTaxYearAmt
Total$53,320,847TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$93,945CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$61,447CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$23,513CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$791CurrentTaxYearMinus1YearAmt
Total$179,696TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$93,945CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$61,447CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$23,513CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$791CurrentTaxYearMinus1YearAmt
Total$179,696TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$53,141,151PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$6CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$9CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$232CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,882CurrentTaxYearMinus1YearAmt
Current Tax Year$611CurrentTaxYearAmt
Total$3,740TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$6CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$9CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$232CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,882CurrentTaxYearMinus1YearAmt
Current Tax Year$611CurrentTaxYearAmt
Total$3,740TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,715,004CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$9,729,150CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$10,293,455CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$11,488,421CurrentTaxYearMinus1YearAmt
Current Tax Year$13,098,557CurrentTaxYearAmt
Total$53,324,587TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99660PublicSupportCY509Pct
Public Support PY5090.99540PublicSupportPY509Pct
Investment Income CY0.00010InvestmentIncomeCYPct
Investment Income PY0.00010InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$222,335BeginningYearBalanceAmt
Investment Earnings Or Losses$12,773InvestmentEarningsOrLossesAmt
End Year Balance$235,108EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$216,937BeginningYearBalanceAmt
Investment Earnings Or Losses$8,280InvestmentEarningsOrLossesAmt
Grants Or Scholarships$2,882GrantsOrScholarshipsAmt
End Year Balance$222,335EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$121,377BeginningYearBalanceAmt
End Year Balance$121,377EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$127,237BeginningYearBalanceAmt
Other Expenditures$5,860OtherExpendituresAmt
End Year Balance$121,377EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$127,237BeginningYearBalanceAmt
End Year Balance$121,377EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.48370BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.51630PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$40,648OtherCostOrOtherBasisAmt
Book Value$40,648BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$30,200,463OtherCostOrOtherBasisAmt
Depreciation$8,951,941DepreciationAmt
Book Value$21,248,522BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,361,386OtherCostOrOtherBasisAmt
Depreciation$1,993,648DepreciationAmt
Book Value$1,367,738BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$10,909OtherCostOrOtherBasisAmt
Book Value$10,909BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$22,667,817TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescRELATED PARTY PAYABLEDesc
Amt$1,814,357Amt
FieldValueIRS element (for citing)
Total Liability$1,814,357TotalLiabilityAmt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, LINE 2B:THE ORGANIZATION HOLDS SECURITY DEPOSITS UNDER LEASE AGREEMENTS WHICH ARE REFUNDABLE BACK TO THE TENANTS AT LEASE TERMINATION.
PART V, LINE 4:BETHANY HOME, INC. HOLDS A PERMANENTLY RESTRICTED ENDOWMENT. THE INVESTMENT INCOME ON THE PERMANENT ENDOWMENT FUNDS ARE AVAILALBE FOR CHARITABLE PURPOSES OF BETHANY HOME, INC.

Schedule M IRS990ScheduleM

Cars And Other Vehicles CarsAndOtherVehiclesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution2ContributionCnt
Noncash Contributions Rpt F990$68,710NoncashContributionsRptF990Amt
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Form8283 Received0Form8283ReceivedCnt
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6BETHANY HOME, INC. MEMBERSHIP CONSISTS OF 32 CHURCH CONGREGATIONS FROM WAUPACA, THE SURROUNDING RURAL AREAS, AND SEVERAL NEIGHBORING COMMUNITIES.
FORM 990, PART VI, SECTION B, LINE 11BTHE FINANCE COMMITTEE REVIEWS THE FORM 990 BEFORE BRINGING IT TO THE BOARD OF DIRECTORS FOR APPROVAL TO FILE.
FORM 990, PART VI, SECTION B, LINE 12CTHE CONFLICT OF INTEREST STATEMENT IS DIRECTED NOT ONLY TO DIRECTORS AND OFFICERS, BUT TO ALL EMPLOYEES WHO CAN INFLUENCE THE ACTIONS OF BETHANY HOME, INC. THIS WOULD INCLUDE ALL WHO MAKE PURCHASING DECISIONS, ALL PERSONS WHO MIGHT BE DESCRIBED AS "MANAGEMENT PERSONNEL, AND ANYONE WHO HAS PROPRIETARY INFORMATION CONCERNING BETHANY HOME, INC. IT IS ASSUMED THAT THE DIRECTORS, OFFICERS, AND MANAGEMENT EMPLOYEES WILL RECOGNIZE CONFLICTS OF INTEREST WITH ANY PERSONS OR FIRMS MENTIONED IN THE POLICY. IT IS THE POLICY OF THE BOARD THAT THE EXISTENCE OF ANY INTERESTS DESCRIBED IN THE POLICY SHALL BE DISCLOSED BEFORE ANY TRANSACTION IS CONSUMMATED. IT SHALL BE THE CONTINUING RESPONSIBILITY OF THE BOARD, OFFICERS, AND MANAGEMENT EMPLOYEES TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS AND IMMEDIATELY MAKE SUCH DISCLOSURES. DISCLOSURE IN THE ORGANIZATION SHOULD BE MADE TO THE ADMINISTRATOR/CEO (IF SHE/HE IS THE ONE WITH THE CONFLICT, THEN THE BOARD CHAIR), WHO SHALL BRING THE MATTER TO THE ATTENTION OF THE BOARD. DISCLOSURE INVOLVING DIRECTORS SHOULD BE MADE TO THE BOARD CHAIR (IF SHE/HE IS THE ONE WITH THE CONFLICT, THEN THE BOARD VICE-CHAIR) WHO SHALL BRING THESE MATTERS TO THE BOARD. THE BOARD SHALL DETERMINE WHETHER A CONFLICT EXISTS AND IN THE CASE OF AN EXISTING CONFLICT, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR, AND REASONABLE TO BETHANY HOME, INC. THE DECISION OF THE BOARD ON THESE MATTERS WILL REST IN THEIR SOLE DISCRETION, AND THEIR CONCERN MUST BE WITH THE WELFARE OF BETHANY HOME, INC. AND THE ADVANCEMENT OF ITS PURPOSE.
FORM 990, PART VI, SECTION B, LINE 15ABETHANY HOME UTILIZES AN INDEPENDENT THIRD PARTY AND LEADINGAGE WI TO PERFORM A SALARY SURVEY ANNUALLY. THE PERSONNEL COMMITTEE RECOMMENDS A FINAL SALARY TO THE BOARD OF DIRECTORS FOR APPROVAL. THE BOARD IS INDEPENDENT AND USES THE COMPARABILITY STUDIES PROVIDED BY LEADINGAGE WI. THE APPROVAL DECISION IS DOCUMENTED IN THE RELATED BOARD OF DIRECTORS MEETING MINUTES.
FORM 990, PART VI, SECTION C, LINE 19BETHANY HOME, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XII, LINE 2CTHE PROCESS IS CONSISTENT WITH PRIOR YEARS.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1BETHANY SHADOW WOODS INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11226 BERLIN STREETAddressLine1Txt
CityWAUPACACityNm
State AbbreviationWIStateAbbreviationCd
ZIP54981ZIPCd
FieldValueIRS element (for citing)
EIN391948898EIN
Primary ActivitiesTO PROVIDE INDEPENDENT RETIREMENT LIVING FACILITIES/SERVICES.PrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 10PublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1BETHANY HOME INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationYes (1)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (1)LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
BETHANY SHADOW WOODS INC
L$105,600COST
BETHANY SHADOW WOODS INC
E$623,257COST