2021-07-26T11:36:45-05:00 2020-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-10-01 390868849 BETHANY HOME INC BETH 7152585521 1226 BERLIN STREET WAUPACA WI 54981 SHELLY SONTAG CEO 7152585521 2021-06-29 1 MICHAEL J PETERSON CPA P01833529 2187224705 2021-06-29 2019 2022-09-23 18:48:47Z SHELLY SONTAG 1226 BERLIN STREET WAUPACA WI 54981 13104400 0 X WWW.BETHANYOFWAUPACA.COM X 1961 WI TO PROVIDE A CHRISTIAN HOME FOR AGED AND INFIRM MEN AND WOMEN WHO NEED THE SERVICES OF THE HOME. 9 9 378 18 0 0 66760 586439 11375376 12487742 -2259 6454 43403 23765 11483280 13104400 0 0 0 0 7193722 6870154 0 0 0 5757929 5988481 12951651 12858635 -1468371 245765 26530764 26868701 27170364 27249763 -639600 -381062 X BETHANY HOME IS ORGANIZED TO PROVIDE A CHRISTIAN HOME FOR AGED AND INFIRM MEN AND WOMEN WHO NEED THE SERVICES OF THE HOME. 0 0 8505127 0 8874725 NURSING 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. 1783598 0 1861106 HEARTWOOD - 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. 1678951 0 1751911 BETHANY 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. 11967676 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 10 0 378 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 WI X KERRY LEE BLANKE FINANCE DIRECTOR 7159421412 1226 BERLIN STREET WAUPACA WI 54981 SHELLY SONTAG ADMINISTRATOR/CEO 35.00 5.00 X 89619 0 6342 KERRY LEE BLANKE FINANCE DIRECTOR 35.00 5.00 X 47445 0 0 GLEN BULLICK PRESIDENT 0.40 0.10 X X 0 0 0 PAUL ONAN VICE PRESIDENT 0.40 0.10 X X 0 0 0 BIL SUTLIEF SECRETARY/ TREASURER 0.40 0.10 X X 0 0 0 VICKI GROTH DIRECTOR 0.40 0.10 X 0 0 0 WAYNE LUCK DIRECTOR 0.40 0.10 X 0 0 0 ROBERT NYGAARD DIRECTOR (THROUGH JUNE) 0.40 0.10 X 0 0 0 JEFF OESTREICH DIRECTOR 0.40 0.10 X 0 0 0 WILSON ROANE DIRECTOR 0.40 0.10 X 0 0 0 ERIN TUBBS DIRECTOR 0.40 0.10 X 0 0 0 DALE WILSON DIRECTOR 0.40 0.10 X 0 0 0 137064 0 6342 1 0 0 0 GENESIS ELDERCARE REHABILITATION SERVICE PO BOX 821322 PHILADELPHIA PA 19182 THERAPY CONTRACTOR 676274 WIPFLI LLP 11 SCOTT STREET SCOTT STREET WAUSAU WI 54403 ACCOUNTING SERVICES 106846 2 567185 19254 68710 586439 RESIDENT SERVICE REVENUE 623000 8398447 8398447 BETHANY PINES RENTAL 532000 3613017 3613017 BETHANY SHADOW WOODS SERVICE AGRE 900099 105600 105600 370678 370678 12487742 611 611 5843 0 5843 5843 5843 BEAUTY SHOP 900099 14771 14771 CAFETERIA 722514 8994 8994 23765 13104400 12487742 0 30219 250240 227344 22896 5382080 4889639 492441 75752 67393 8359 715375 636323 79052 446707 397569 49138 8457 8457 51130 51130 217250 217250 57689 57689 382681 382681 44081 44081 352145 352145 23626 22404 1222 11356 6920 4436 630795 630795 1349054 1281601 67453 107344 107344 PROGRAM SUPPLIES 1055810 1055810 THERAPIES 535524 535524 T19 ASSESSMENT 191250 191250 BAD DEBT EXPENSE 176090 176090 794199 731905 62294 12858635 11967676 890959 0 601732 2045355 825326 810818 975075 951897 42761 62717 63321 49989 33613406 10945589 23800214 22667817 222335 235108 0 45000 26530764 26868701 1404406 808762 0 132191 66142 56096 24966170 24438357 733646 1814357 27170364 27249763 X -869860 -569261 230260 188199 -639600 -381062 26530764 26868701 245765 12773 0 X X 0 1 X 1 0 X 16621 25680 52238 66760 586439 747738 8635630 9628513 10197576 11375376 12487742 52324837 62747 74948 43409 43403 23765 248272 8714998 9729141 10293223 11485539 13097946 53320847 0 93945 61447 23513 791 179696 93945 61447 23513 791 179696 53141151 6 9 232 2882 611 3740 6 9 232 2882 611 3740 8715004 9729150 10293455 11488421 13098557 53324587 0.99660 0.99540 0.00010 0.00010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 222335 12773 235108 216937 8280 2882 222335 121377 121377 127237 5860 121377 127237 121377 0.48370 0.51630 0.00000 0 0 40648 40648 30200463 8951941 21248522 3361386 1993648 1367738 10909 10909 22667817 RELATED PARTY PAYABLE 1814357 1814357 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. X 2 68710 FAIR MARKET VALUE 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 BETHANY 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 11B THE 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 12C THE 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 15A BETHANY 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 19 BETHANY HOME, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE PROCESS IS CONSISTENT WITH PRIOR YEARS. BETHANY SHADOW WOODS INC 1226 BERLIN STREET WAUPACA WI 54981 391948898 TO PROVIDE INDEPENDENT RETIREMENT LIVING FACILITIES/SERVICES. WI 501(C)(3) LINE 10 BETHANY HOME INC 1 0 0 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 0 BETHANY SHADOW WOODS INC L 105600 COST BETHANY SHADOW WOODS INC E 623257 COST